Pathology/Lab Coding Alert

Learn test codes with multiple targets.

You just mastered coding for lab tests to pinpoint SARS-CoV-2 antigens or antibodies, but how do you report a test for multiple respiratory pathogens, including SARS-CoV-2?

Because many COVID-19 symptoms are similar to other common respiratory viral infections, such as colds and flu, clinicians may order a lab test to identify infection with SARS-CoV-2 or other common organisms such as influenza A or B or respiratory syncytial virus.

You have the following three CPT^® Category 1 codes to choose from for these tests:

• 87428 (Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemilumino­metric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B)
• 87636 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique)
• 87637 (… severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique)

Lab method distinguishes these codes, with 87428 describing an antigen immunoassay method that may allow a rapid test to determine if a patient’s symptoms are due to COVID-19 from a SARS-CoV-2 infection or the flu from an influenza virus infection.

Contrast: Codes 87636 and 87637 use nucleic acid target analysis, and typically do not provide rapid results, according to William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

These two codes describe similar tests, except 87637 includes an additional target of respiratory syncytial virus in addition to influenza A and B.

Check Out PLA Respiratory Pathogen Panels

CPT^® provides a host of proprietary laboratory analyses (PLA) codes that describe various methods and targets for respiratory pathogens by specific labs or manufacturers, as follows:

• 0202U (Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected) for BioFire^® FilmArray® Respiratory Panel 2.1
• 0223U same definition as 0202U, for QIAstat-Dx^® Respiratory SARS CoV-2 Panel from QIAGEN Sciences
• 0225U (Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected) for ePlex^® Respiratory Pathogen Panel 2, GenMark from GenMark Diagnostics
• 0240U (Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected) for Xpert^® Xpress SARS-CoV-2/Flu/RSV (SARS-CoV-2 & Flu targets only) from Cepheid
• 0241U (Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected) for Xpert^® Xpress SARS-CoV-2/Flu/RSV (all targets) from Cepheid

Coding tip: Remember that PLA codes take precedence over any other CPT^® code for the specific proprietary test.