How To Use CPT Code 87906

CPT 87906 describes the analysis of the genotype of an HIV 1 virus by nucleic acid for regions other than the reverse transcriptase and protease regions. 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 87906?

CPT 87906 can be used to describe the analysis of the genotype of an HIV 1 virus by nucleic acid for regions other than the reverse transcriptase and protease regions. This code is used when the lab analyst performs the technical lab test to analyze specific genes, such as the integrase gene or fusion gene, of the HIV 1 virus genotype using nucleic acid testing.

2. Official Description

The official description of CPT code 87906 is: ‘Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion)’. Please note that this code should not be used for the analysis of the reverse transcriptase and protease regions, which fall under CPT code 87901.

3. Procedure

1. The lab analyst performs the technical lab test to analyze the genotype of an HIV 1 virus by nucleic acid for regions other than the reverse transcriptase and protease regions.
2. This analysis typically involves reverse transcriptase polymerase chain reaction (RT PCR) to clone the RNA or DNA sequence of interest and amplify the results.
3. The specific genes included in the HIV 1 virus, such as the integrase gene or fusion gene, are sequenced and analyzed to determine resistance to drugs that affect these areas of the gene.
4. The sample used for this test is the patient’s serum, which is the clear liquid portion of blood that does not contain cellular components.

4. Qualifying circumstances

CPT 87906 is typically ordered by clinicians when an HIV positive patient shows resistance to drug therapy. It is used to determine the genotype of the HIV 1 virus for regions other than the reverse transcriptase and protease regions, such as the integrase gene or fusion gene. This test helps clinicians identify the specific genes that may be causing resistance to certain drugs, allowing them to adjust the patient’s drug regimen accordingly.

5. When to use CPT code 87906

CPT code 87906 should be used when the analysis of the genotype of an HIV 1 virus is performed using nucleic acid testing for regions other than the reverse transcriptase and protease regions. It should not be used for the analysis of the reverse transcriptase and protease regions, which have their own specific code (CPT 87901).

6. Documentation requirements

To support a claim for CPT 87906, the documentation should include:

• Reason for ordering the test, such as drug resistance in an HIV positive patient
• Specific genes analyzed, such as the integrase gene or fusion gene
• Date of the test
• Method used for the analysis, such as reverse transcriptase polymerase chain reaction (RT PCR)
• Results of the analysis and any drug resistance identified
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87906, ensure that the analysis is performed for regions other than the reverse transcriptase and protease regions of the HIV 1 virus. It should not be reported if CPT codes 87901 have already been performed in the previous seven days. Additionally, check payer policies for any frequency limitations on this test. Some payers may only cover a certain number of these tests for a patient each year. It is also important to note that some payers may pay separately for the collection of the specimen using a different code, such as CPT 36415 for venous blood collection.

8. Historical information

CPT 87906 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the analysis of the genotype of an HIV 1 virus by nucleic acid for the integrase gene to determine drug resistance in an HIV positive patient.
2. The nucleic acid testing is used to analyze the fusion gene of the HIV 1 virus to identify specific genes causing drug resistance in an HIV positive patient.
3. During the analysis, the lab analyst sequences and analyzes the specific genes included in the HIV 1 virus, such as the integrase gene, to determine resistance to drugs affecting these areas of the gene.
4. A clinician orders the analysis of the genotype of an HIV 1 virus by nucleic acid for the fusion gene to adjust the drug regimen for an HIV positive patient showing resistance to current therapy.
5. The lab analyst performs the analysis of the genotype of an HIV 1 virus by nucleic acid for the integrase gene to guide the selection of appropriate drugs for an HIV positive pregnant patient.
6. Using nucleic acid testing, the lab analyst analyzes the specific genes, such as the fusion gene, of the HIV 1 virus to determine drug resistance in an HIV positive patient with a viral load greater than 500.