How To Use CPT Code 87806

CPT 87806 describes the process of infectious agent antigen detection by immunoassay with direct optical observation. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 87806?

CPT 87806 can be used to identify the presence of HIV type 1 or type 2 strain in a patient’s blood through infectious agent antigen detection. This code is used when a lab analyst conducts tests to detect the protein enveloping the virus, known as the p24 antigen. By conducting this test, healthcare providers can screen for HIV infection and determine if further confirmatory testing is necessary.

2. Official Description

The official description of CPT code 87806 is: ‘Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies.’

3. Procedure

1. The lab analyst collects a blood sample from the patient through routine vein puncture.
2. The analyst adds monoclonal antibodies to the blood sample.
3. If the p24 antigen is present in the blood, the antibodies will bind to it.
4. The analyst introduces an enzyme-linked antibody that causes a color change if the p24 antigen is present.
5. The color change indicates the presence of HIV type 1 or type 2 strain in the patient’s blood.

4. Qualifying circumstances

CPT 87806 is used when healthcare providers suspect HIV infection in a patient and need to confirm the presence of HIV type 1 or type 2 strain. This test is not limited to testing for a specific condition and can be ordered as a first test to screen for HIV infection. It is important to note that a positive result from this test requires further confirmatory testing before diagnosing the patient as HIV positive.

5. When to use CPT code 87806

CPT code 87806 should be used when healthcare providers need to detect the presence of HIV type 1 or type 2 strain in a patient’s blood. This code is appropriate for initial screening tests and should be followed by confirmatory testing if the results are positive. It is important to use this code when the immunoassay with direct optical observation method is used for antigen detection.

6. Documentation requirements

To support a claim for CPT 87806, healthcare providers must document the following information:

• Patient’s symptoms or risk factors that warrant HIV testing
• Date and time of the test
• Results of the test, including whether it is positive or negative
• Any additional confirmatory testing performed
• Signature of the lab analyst conducting the test

7. Billing guidelines

When billing for CPT 87806, ensure that the test is performed by a qualified lab analyst using the immunoassay with direct optical observation method. It is important to follow the specific guidelines provided by payers for proper reimbursement. Additionally, consider using other relevant codes, such as 36415 for specimen collection or 86689 for Western blot testing for related conditions.

8. Historical information

CPT 87806 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst conducting an immunoassay with direct optical observation to detect HIV type 1 antigen in a patient’s blood.
2. A healthcare provider ordering CPT 87806 as an initial screening test for a patient with potential HIV exposure.
3. A lab analyst performing the test to confirm the presence of HIV type 2 strain in a patient’s blood.
4. A healthcare provider using CPT 87806 to monitor the effectiveness of antiretroviral therapy in a patient with HIV infection.
5. A lab analyst conducting the test to screen blood donations for HIV infection.
6. A healthcare provider ordering CPT 87806 to determine the HIV status of a pregnant patient.
7. A lab analyst performing the test to detect HIV infection in a patient with symptoms suggestive of acute retroviral syndrome.
8. A healthcare provider using CPT 87806 to screen high-risk individuals for HIV infection during routine check-ups.
9. A lab analyst conducting the test to confirm the presence of HIV type 1 and type 2 strain in a patient’s blood.
10. A healthcare provider ordering CPT 87806 to assess the HIV status of a patient before starting immunosuppressive therapy.