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87801 Billing

Apurva Posted Thu 21st of May, 2020 06:11:09 AM
In a UTI panel of 21 organisms we have 3 specific individual organism CPT codes and rest of the organism is being billed with CPT 87798. Need clarification whether can we bill CPT 87801 for multiple organisms of the same species . Example : Can we bill ENTEROBACTER AEROGENES , ENTEROBACTER CLOACAE ,KLEBSIELLA PNEUMONIAE,KLEBSIELLA OXYTOCA,ENTEROCOCCUS FAECALIS,ENTEROCOCCUS FAECIUM with 87801*3 instead of 87798*6
SuperCoder Answered Fri 22nd of May, 2020 12:33:00 PM

Hi Apurva,

In CPT 87798 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism), the lab analyst processes the specimen from a direct source such as blood and performs amplification techniques, such as polymerase chain reaction (PCR) that results in a millionfold increase in the number of copies of a specific target nucleic acid sequence. The lab analyst then assesses the presence of the amplified nucleic acid sequences that indicate the presence of an infectious agent not specified in another code using a nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA used to join with the complementary sequence in the specimen through a process called hybridization. The nucleic acid probe includes a label, such as a radioactive or chemical tag, that allows the lab analyst to visualize the hybridization product. Although not limited to testing for a specific condition, providers may order this test if they are looking for a rare cause of an infection, perhaps if testing for all the usual organisms has been reported as negative. For example, Vibrio metschnikovii is a rare cause of wound infections after surgery. Use code 87798 if the clinician orders Vibrio metschnikovii detection by nucleic acid, amplified probe technique.

Whereas, in CPT 87801 (Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique) , the lab analyst processes the specimen from a direct source such as sputum, pleural fluid from the chest, throat swab, or nasopharyngeal washings, and performs amplification techniques, such as polymerase chain reaction, called PCR, that results in a millionfold increase in the number of copies of specific target nucleic acid sequences. The lab analyst then assesses the presence of the amplified nucleic acid sequences that indicate the presence of the infectious agents using a nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA used to join with the complementary sequence in the specimen through a process called hybridization. The nucleic acid probes include a label, such as a radioactive or chemical tag, that allows the lab analyst to visualize the hybridization products. Amplified probe techniques enable the detection of very minute amounts of infective organisms.

There is difference in performance of both the tests, CPT 87798 is for organism not otherwise specified, whereas, CPT 87801 represents a single test that involves multiple probes for multiple organisms. So, check your process of procedure, specificity of organism and code accordingly.

Hope this helps!

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