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CPT 87801 vs 87798

Apurva Posted Mon 09th of December, 2019 06:45:38 AM
Need clarification as to when CPT's 87801 and 87798 can be billed. For Example : If Enterobacter aerogenes, Enterobacter cloacae, Enterococcus faecalis, Enterococcus faecium is run . Can we bill 87801 instead of 87798*4. If yes how many units of 87801.
SuperCoder Answered Tue 10th of December, 2019 05:12:27 AM

Hi Apurva,


When using nucleic acid amplification techniques to test for a single infectious organism that lacks a specific CPT code in the 87470-87660 range, billing a single unit of CPT code 87798 is appropriate. When nucleic acid amplification techniques are used to test for more than one infectious organism in a specimen, whether or not a specific CPT code in the 87470-87660 range is available (such as in an infectious disease panel), billing a single unit of CPT code 87801 is appropriate. 


Since this code is each organism-based code, you can bill 4 units, if four organisms were detected by amplified probe technique. You can bill up to maximum of 13 units for this code. 



Apurva Posted Tue 10th of December, 2019 05:49:27 AM
Thank You for the reply . Need further details in billing 87801and related links if any with examples
SuperCoder Answered Wed 11th of December, 2019 02:31:47 AM

Hi Apurva,


The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe 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 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. 


Use this code to represent a single test that involves multiple probes for multiple organisms.



Use 87801 when the analyst performs a single test that involves amplifying multiple DNA target sequences using any of several techniques, including polymerase chain reaction, ligase chain reaction, or signal detection.


Please find below SuperCoder newsletter link for more understanding:



Apurva Posted Wed 11th of December, 2019 03:47:57 AM
Thanks for the reply ,It would be helpful if we could understand under what scenario we can bill Multiple times since we have an MUE of 3 for the CPT .(87801*3 )
SuperCoder Answered Thu 12th of December, 2019 02:39:26 AM

Hi Apurva,


Multiple units for this code can be billed for different species or strains when reported by the same code. If multiple organism of the same species are reported use MUE =1. If multiple organisms of two different species/strains are reported, use MUE=2


Hope provided information would be helpful.



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