Pathology/Lab Coding Alert

Capture multiple targets with one code.

If your lab performs one of the new commercial panels to detect gastrointestinal (GI) pathogens, you haven’t had an accurate CPT® code to report the service — until now. 

Make sure you’re ready to use three new codes to report your GI pathogen nucleic acid screening tests when 2015 rolls around. 

Count Targets to Choose Code

When CPT® 2015 goes into effect on Jan.1, you’ll have the following three new codes to report the service:

• 87505 — Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets
  
• 87506 — … gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets
  
• 87507 — … gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets.
  

These codes describe tests to detect and identify nucleic acids from multiple bacteria, viruses, or parasites in a fecal specimen of a patient with symptoms of a GI tract infection. 

Distinguish the three codes based on the number of targets, which are nucleic acid sequences from specific organisms that the test seeks. 

Understand ‘Multiplex’

New codes 87505-87507 are in the CPT® microbiology section for infectious agent detection by nucleic acid (DNA or RNA) probe, which the code set organizes alphabetically by infectious organism name. You’ll find the new codes listed following the existing codes for enterovirus and enterococcus. 

The big difference in these new codes is that the nucleic acid probes are not for just one organism, but instead, provide targets for multiple organisms that might cause a GI infection.

“New codes 87505-87507 are modelled after existing codes for respiratory viral pathogens, 87631-87633 [Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus …]. The codes are used for multiplex panel formats that detect multiple specific pathogens with similar clinical presentations,” explains Vickie Baselski, PhD, D(ABMM), F(AAM), professor of pathology and laboratory medicine at the University of Tennessee Health Science Center in Memphis.

Multiple probes: A multiplex probe technique involves a single test that simultaneously interrogates multiple nucleic acid sequences, called targets. The multiple probes may be for multiple types or subtypes of a single organism, or for multiple organisms. 

Reverse transcription: “The terminology ‘includes multiplex reverse transcription, when performed’ allows 87505-87507 to be applicable for component assays using reverse transcription of RNA targets, as well as assay formats for DNA targets, or any other methods not requiring a reverse transcription,” Baselski says. 

That’s because the tests provide similar information — a pathogen is present or not — using the various molecular formats. 

Target Number is Key

The distinguishing feature between the three new codes for GI pathogens is how many targets the panel includes. The break down is three to five targets for 87505, six to 11 targets for 87506, and 12 to 25 targets for 87507. 

Named pathogens: Although the code descriptors list multiple organisms — Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia — these are examples only. The panel does not have to detect nucleic acids from all of these organisms, or from only these organisms, to warrant using the codes. 

Bottom line: Select the proper code based on the number of targets, regardless of the number of organisms or which GI infectious agents the test investigates.