How To Use CPT Code 87913

CPT 87913 describes the analysis of the genotype of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease (COVID-19). 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 87913?

CPT 87913 can be used to describe the analysis of the genotype of the SARS-CoV-2 virus in patients with confirmed COVID-19. This test utilizes next-generation sequencing to identify mutations in the virus that may impact disease severity or transmissibility.

2. Official Description

The official description of CPT code 87913 is: ‘Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s).’ This code should be used specifically for the analysis of SARS-CoV-2 mutations and not for the detection of the virus itself.

3. Procedure

1. The lab analyst receives a specimen, typically a nasopharyngeal swab, from a patient with confirmed COVID-19.
2. The specimen is processed, and viral nucleic acids are extracted.
3. The extracted nucleic acids are amplified using reverse transcription polymerase chain reaction (RT-PCR) to increase the number of gene sequences in targeted regions.
4. Next-generation sequencing (NGS) is performed to compare the specimen to reference mutations, such as alterations in the viral spike (S) protein.
5. Bioinformatics is used to interpret the results and identify any mutations in the SARS-CoV-2 virus.

4. Qualifying circumstances

CPT 87913 is appropriate for patients who have tested positive for SARS-CoV-2 and require further analysis of the virus’s genotype. This analysis can help guide treatment decisions, such as distinguishing between persistent infection and reinfection with a new viral strain, or identifying mutations that may impact the effectiveness of antiviral medications or vaccine-induced antibodies.

5. When to use CPT code 87913

CPT code 87913 should be used when there is a need to analyze the genotype of the SARS-CoV-2 virus in patients with confirmed COVID-19. It is important to note that this code should not be used for the diagnosis of SARS-CoV-2 infection itself, as there are specific codes available for that purpose.

6. Documentation requirements

To support a claim for CPT 87913, the following documentation should be included:

• Confirmation of the patient’s positive SARS-CoV-2 PCR test
• Details of the specific mutations or targeted regions analyzed
• Date of service and the specific specimen analyzed
• Results of the analysis, including any identified mutations
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 87913, ensure that the analysis is performed on a single specimen on a single date of service. It is important to note that some payers may not cover the test when used for epidemiological purposes. Additionally, it is crucial to use the appropriate codes for the diagnosis of SARS-CoV-2 infection, such as CPT codes 87635-87637, instead of CPT 87913.

8. Historical information

CPT 87913 was added to the Current Procedural Terminology system on February 21, 2022. There have been no updates to the code since its addition.

9. Examples

1. A patient with confirmed COVID-19 undergoes genotype analysis of the SARS-CoV-2 virus to determine if they have been infected with a new viral strain.
2. A healthcare provider orders genotype analysis for a patient with persistent COVID-19 symptoms to identify any mutations that may impact treatment decisions.
3. A patient who has received antiviral medications undergoes genotype analysis to assess the effectiveness of the treatment.
4. A healthcare facility conducts genotype analysis on a group of COVID-19 patients to track the prevalence of specific viral mutations within the population.
5. A patient who has received a COVID-19 vaccine undergoes genotype analysis to assess the impact of the vaccine on the virus’s mutations.