Oncology & Hematology Coding Alert

Question: In a patient with carcinoma and suspected to have a histoplasmosis infection, our physician recommended some laboratory tests to confirm the diagnosis. The tests were done in the hospital laboratory. How can we submit claims for these tests?

Florida Subscriber

Answer: To aid the diagnosis of histoplasmosis, your physician can only write an order. These tests are done in a laboratory and are billed by the laboratory. Some common tests are antigen detection tests, antibody assays, and culture. The laboratory may report code 87385 (Infectious agent antigen detection by immunoassay technique, [e.g., enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), immunochemiluminometric assay (IMCA)] qualitative or semiquantitative, multiple-step method; Histoplasma capsulatum) for immunoassay testing for antigen detection. Alternatively, your physician may order an antibody test to help diagnose histoplasmosis. The lab would report antibody testing using 86698 (Antibody; histoplasma).

Newer tests: There is increasing trend to use the newer antigen test that identifies nucleic acids using real time polymerase chain reaction (PCR), but CPT® does not yet provide a specific code for the test. If you perform that method to identify Histoplasmosis antigens, you should use an appropriate unlisted code such as 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism).

Culture: Growing the fungus from a patient specimen on a microbiology culture is the gold-standard for diagnosing Histoplasmosis infection. Because culture results may take weeks, physicians often order a culture at the same time as one of the previously-mentioned lab tests.

You should report the fungal culture as 87102 (Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source [except blood]) or 87103 (… blood) for one of the common specimen sources for suspected histoplasmosis: sputum, blood, or other body fluid.

For any other additional tests for definitive identification, you can also list 87106 (Culture, fungi, definitive identification, each organism; yeast).