How To Use CPT Code 87901

CPT 87901 describes the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype using nucleic acid (DNA or RNA) by a lab analyst. 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 87901?

CPT 87901 can be used to describe the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype using nucleic acid (DNA or RNA) by a lab analyst. This code is used when the lab analyst performs all the technical steps to analyze a patient’s specimen, typically serum, to determine the specific genotype of the HIV-1 virus.

2. Official Description

The official description of CPT code 87901 is: ‘Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions.’

3. Procedure

1. The lab analyst receives the patient’s specimen, usually serum, for analysis.
2. The analyst uses a procedure such as polymerase chain reaction (PCR) to multiply the number of copies of the specific nucleic acid (DNA or RNA) of the HIV-1 virus in the specimen.
3. A nucleic acid probe containing the specific reverse transcriptase and protease regions of a particular genotype of the HIV-1 virus is used.
4. The analyst determines the specific genotype of the HIV-1 virus by comparing the nucleic acid probe with the amplified nucleic acid in the specimen.

4. Qualifying circumstances

CPT 87901 is performed when a patient with HIV-1 infection requires analysis of the reverse transcriptase and protease regions of the virus genotype. This analysis helps determine the specific genotype of the virus, which is important for selecting appropriate antiretroviral medications. The analysis may be ordered if the patient is not responding to prescribed retroviral therapy or to determine the most effective treatment for the patient.

5. When to use CPT code 87901

CPT code 87901 should be used when a lab analyst performs the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype using nucleic acid (DNA or RNA). This code is specific to the analysis of the HIV-1 virus and should not be used for other infectious agents or genotypes.

6. Documentation requirements

To support a claim for CPT 87901, the lab analyst must document the following information:

• Patient’s HIV-1 positive status
• Specific specimen analyzed (e.g., serum)
• Date of analysis
• Procedure used for amplification (e.g., PCR)
• Nucleic acid probe used for analysis
• Specific reverse transcriptase and protease regions analyzed
• Result of the analysis indicating the specific genotype of the HIV-1 virus

7. Billing guidelines

When billing for CPT 87901, ensure that the analysis is performed by a lab analyst and that the specific reverse transcriptase and protease regions of the HIV-1 virus genotype are analyzed. This code should not be reported with other codes for genotype or phenotype assays. It is important to follow payer-specific guidelines and include any necessary modifiers for accurate billing.

8. Historical information

CPT 87901 was added to the Current Procedural Terminology system on January 1, 2001. Since its addition, there have been several code changes to refine the description and ensure accuracy in reporting.

9. Examples

1. A lab analyst performs the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype using nucleic acid (DNA or RNA) for a patient with HIV-1 infection.
2. The lab analyst uses a nucleic acid probe to determine the specific genotype of the HIV-1 virus in a patient’s serum specimen.
3. An HIV-positive patient who is not responding to retroviral therapy undergoes analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype to determine the most effective treatment.
4. A clinician orders the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype for a patient with HIV-1 infection to assess drug resistance.
5. The lab analyst performs the analysis of the reverse transcriptase and protease regions of the HIV-1 virus genotype using nucleic acid (DNA or RNA) to guide the selection of antiretroviral medications for a patient with HIV-1 infection.