How To Use CPT Code 87900

CPT 87900 describes the prediction of infectious agent drug susceptibility phenotype using regularly updated genotypic bioinformatics. 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 87900?

CPT 87900 can be used to predict the behavior of infectious agent drug susceptibility phenotype in patients. This test compares patient data to regularly updated genotypic bioinformatics to determine the patient’s susceptibility or resistance to drugs targeting a specific virus. The results of this test can help clinicians in deciding which drugs to prescribe for their patients.

2. Official Description

The official description of CPT code 87900 is: ‘Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics.’

3. Procedure

1. The lab analyst performs all technical steps to determine drug susceptibility in a patient.
2. The lab analyst creates a phenotype prediction using regularly updated genotypic bioinformatics.
3. The patient’s data is compared to a large genotype and phenotype database to determine the patient’s susceptibility to various drugs.
4. The prediction results are provided to the clinician to assist in determining the correct drug regimen for the patient.

4. Qualifying circumstances

CPT 87900 is typically ordered for patients with human immunodeficiency virus (HIV) who are not responding to treatment. It is also ordered for HIV-positive pregnant patients to ensure correct drug therapy. Patients generally need a viral load of greater than 500 for a clinician to order this test.

5. When to use CPT code 87900

CPT code 87900 should be used when there is a need to predict the infectious agent drug susceptibility phenotype in patients. It is particularly useful for HIV patients who are not responding to treatment or for HIV-positive pregnant patients who require accurate drug therapy.

6. Documentation requirements

To support a claim for CPT 87900, the following documentation is required:

• Patient’s diagnosis and indication for drug susceptibility testing
• Details of the genotypic bioinformatics used for the prediction
• Date of the test
• Results of the prediction, indicating the patient’s susceptibility to various drugs
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87900, ensure that the test is performed by a qualified lab analyst using regularly updated genotypic bioinformatics. There are no specific guidelines regarding reporting CPT 87900 with other codes. However, it is important to check payer policies for any frequency limitations on this test.

8. Historical information

CPT 87900 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Examples

1. A patient with HIV who is not responding to the current drug regimen undergoes CPT 87900 to determine their drug susceptibility phenotype.
2. An HIV-positive pregnant patient requires CPT 87900 to ensure the correct drug therapy during pregnancy.
3. A clinician orders CPT 87900 for a patient with a viral load greater than 500 to assess their drug susceptibility phenotype.
4. A patient with HIV experiences adverse reactions to certain drugs, prompting the clinician to order CPT 87900 for drug susceptibility prediction.
5. A patient with HIV who has recently been diagnosed undergoes CPT 87900 to determine the most effective drug regimen for their condition.
6. A clinician orders CPT 87900 for a patient with HIV who has experienced treatment failure to guide the selection of alternative drugs.
7. An HIV-positive patient with a history of drug resistance undergoes CPT 87900 to assess their current drug susceptibility phenotype.
8. A patient with HIV who is starting a new drug regimen undergoes CPT 87900 to ensure the selected drugs are effective against their virus.
9. A clinician orders CPT 87900 for a patient with HIV who is experiencing virologic rebound to assess their drug susceptibility phenotype.
10. An HIV-positive patient with a viral load greater than 500 undergoes CPT 87900 to guide the selection of antiretroviral drugs.