Inpatient Facility Coding & Compliance Alert

Question: Our lab tests a bronchial lavage specimen for respiratory viruses by multiplex amplified probe technique and identifies two influenza virus subtypes and three adenovirus subtypes. Should we report 87502 and 87631? 

Texas Subscriber

Answer: No, you should not report 87631 (Infectious agent detection by nucleic acid [DNA or RNA]; respiratory virus [e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus], multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets) with 87502 (Infectious agent detection by nucleic acid [DNA or RNA]; influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types) for the same specimen. 

Instead, you should report the single code that most accurately describes the test you performed, which is 87631.

New codes: CPT^® 2013 adds three new codes for respiratory virus detection, distinguished by the number of type or subtype targets: 87631, 87632 (…6-11 targets), and 87633 (…12-25 targets). These codes describe multiplex tests for any or all of the respiratory viruses. CPT^® also provides separate codes for the individual virus types by similar methodology. 

Principle: You should select the single, most-specific code that describes the virus and method for a single specimen and test.  

Correct Coding Initiative (CCI) 19.0 confirmed this principle by bundling each of the new codes (87631-87633) with the following specific respiratory virus tests.

·         87275 — Influenza B virus

·         87276 — Influenza A virus

·         87279 — Parainfluenza virus, each type

·         87280 — Respiratory syncytial virus

·         87301 — Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; adenovirus enteric types 40/41

·         87400 — Influenza, A or B, each

·         87501 — Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype

·         87502 — Influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types

·         87503 — Influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure)

·         87801 — Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

·         87260 — Infectious agent antigen detection by immunofluorescent technique; adenovirus.

CCI assigns a modifier indicator of “0” to many of these edit pairs, meaning that you can’t unbundle the codes under any circumstances.