How To Use CPT Code 87807

CPT 87807 describes the process of detecting the presence of respiratory syncytial virus (RSV) in a patient specimen using an immunoassay with direct optical observation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 87807?

CPT 87807 can be used to describe the laboratory test performed to detect the presence of respiratory syncytial virus (RSV) in a patient specimen. This test utilizes an immunoassay technique with direct optical observation, meaning that the lab analyst visually observes the results of the test to determine the presence of RSV.

2. Official Description

The official description of CPT code 87807 is: ‘Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; respiratory syncytial virus.’

3. Procedure

1. The lab analyst collects a specimen from the patient, typically a nasopharyngeal swab.
2. The specimen is placed in a reagent containing an antibody specific to respiratory syncytial virus (RSV).
3. The lab analyst then performs an immunoassay, which involves an antibody-antigen reaction, using the specimen and the reagent.
4. The analyst visually observes the results of the immunoassay, looking for any optical indicators that indicate the presence of RSV, such as a color change or the appearance of a line.
5. If the visual observation indicates the presence of RSV, the test is considered positive.
6. If the visual observation does not indicate the presence of RSV, the test is considered negative.

4. Qualifying circumstances

CPT 87807 is typically ordered for patients, especially children or immunocompromised individuals, who have severe respiratory infections that are not improving with treatment. The test is performed to determine if the respiratory syncytial virus (RSV) is the cause of the infection. The lab analyst must perform the test using the immunoassay technique with direct optical observation.

5. When to use CPT code 87807

CPT code 87807 should be used when a healthcare provider orders a laboratory test to detect the presence of respiratory syncytial virus (RSV) in a patient specimen. The test should be performed using the immunoassay technique with direct optical observation. It is important to note that this code should not be used for testing other infectious agents or for tests that do not involve direct optical observation.

6. Documentation requirements

To support a claim for CPT 87807, the healthcare provider must document the following information:

• Reason for ordering the test, such as a severe respiratory infection that is not improving with treatment
• Details of the specimen collected, including the type of specimen (e.g., nasopharyngeal swab)
• Information about the reagent used for the immunoassay
• Date and time of the test
• Results of the visual observation, indicating the presence or absence of respiratory syncytial virus (RSV)
• Signature of the lab analyst who performed the test

7. Billing guidelines

When billing for CPT 87807, ensure that the test is performed using the immunoassay technique with direct optical observation. It is important to follow the specific guidelines provided by the payer regarding the documentation and coding requirements for this test. Additionally, it is essential to review any applicable bundling or unbundling rules to ensure accurate billing.

8. Historical information

CPT 87807 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs an immunoassay with direct optical observation to detect the presence of respiratory syncytial virus (RSV) in a nasopharyngeal swab specimen from a child with a severe respiratory infection.
2. A healthcare provider orders a test to determine if a patient’s persistent respiratory symptoms are caused by respiratory syncytial virus (RSV). The lab analyst performs an immunoassay with direct optical observation using a specimen collected from the patient.
3. A lab analyst visually observes the results of an immunoassay with direct optical observation to detect the presence of respiratory syncytial virus (RSV) in a specimen from an immunocompromised patient with a respiratory infection.
4. A healthcare provider suspects respiratory syncytial virus (RSV) as the cause of a patient’s respiratory symptoms and orders a test. The lab analyst performs an immunoassay with direct optical observation using a specimen collected from the patient.
5. A child with a severe respiratory infection undergoes a test to determine if respiratory syncytial virus (RSV) is the causative agent. The lab analyst performs an immunoassay with direct optical observation using a nasopharyngeal swab specimen.
6. A lab analyst visually inspects the results of an immunoassay with direct optical observation to detect the presence of respiratory syncytial virus (RSV) in a specimen from a patient with persistent respiratory symptoms.
7. A healthcare provider orders a test to confirm the presence of respiratory syncytial virus (RSV) in a patient with a severe respiratory infection. The lab analyst performs an immunoassay with direct optical observation using a specimen collected from the patient.
8. A lab analyst visually examines the results of an immunoassay with direct optical observation to detect the presence of respiratory syncytial virus (RSV) in a specimen from an immunocompromised patient with respiratory symptoms.