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Apurva Posted Tue 08th of October, 2019 23:15:32 PM
We have CANDIDA ALBICANS, CANDIDA GLABRATA, CANDIDA PARAPSILOSIS,CANDIDA TROPICALIS need clarification as to whether we need to bill 87481*1 as the description is Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique. or should be bill 87481*4
SuperCoder Answered Wed 09th of October, 2019 03:32:19 AM

Hi Apurva, 

If a single test procedure is performed that results for multiple species or strains of an organism, only one unit of service of a CPT code may be reported for that test procedure, according to the National Correct Coding Initiative (NCCI).

In the above scenario, a single amplified probe nucleic acid detection test procedure is performed that identifies more than one species of Candida organisms, So, only one unit may be reported for CPT code 87481.

However, if separate medically reasonable and necessary test procedures are performed for different species or strains of an organism, the same CPT code may be reported for each test procedure utilizing modifier 59 for the second and additional test procedures.

Thank you.


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