Pathology/Lab Coding Alert

Reporting 87260-87902 just got easier.

Only a couple of small changes infected the CPT® 2014 microbiology section, but looking at them reminds you that you could stand to brush up on some micro-coding basics — especially when it comes to reporting infectious agent antigen detection.

That’s why we’ve put together this coding primer to give you the tools to accurately report infectious agent antigen detection assays in the 87260-87902 code range. 

Then you can look at “1 Code + 1 Phrase = Microbiology Changes You Need to Know” on page 51 to make sure you’ve mastered the CPT® 2014 microbiology changes. 

Tip 1: Make Sure You’re in the Right ZIP Code 

Labs perform lots of tests to identify disease-causing organisms, and CPT® provides lots of codes to describe those tests. “Not all tests for infectious agents fall under infectious agent antigen detection codes 87260-87902,” cautions William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

So without understanding the big picture, you could easily select a specific organism code — and be completely wrong. But if you can answer “yes” to the following two questions, you’ll know you should be using a code from the range 87260-87902:

Does the lab test for an antigen, not an antibody? The 87260-87902 codes describe tests that identify an antigen, which is a portion of the infecting organism, such as a protein molecule or a gene sequence. CPT® lists many other infectious agent tests that don’t directly identify an antigen, but instead identify an antibody, which is a protein that the body produces in response to the infecting organism. You’ll find those codes in the immunology section (86602-86804).

Is the specimen from a primary source, not a culture? You should use the 87260-87902 codes only for primary source specimens, such as a direct smear from a blood or urine sample. Labs may also perform antigen detection on culture specimens, but you should report those services with a code from the 87140 family (Culture, typing ...). These codes include some of the same detection methods, such as immunofluorescent technique and nucleic acid probe.  

Tip 2: Find the Lab Method Family 

CPT® organizes direct-smear infectious agent antigen detection codes by four primary methods: immunofluorescent technique, enzyme immunoassay, nucleic acid technique, or direct optical observation. Look to the following four “parent codes” to find the CPT® sections that represent testing using these four techniques:

• 87260 — Infectious agent antigen detection by immunofluorescent technique; …
• 87301 — Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; …
• 87470 — Infectious agent detection by nucleic acid (DNA or RNA); …
• 87802 — Infectious agent antigen detection by immunoassay with direct optical observation; …

Coder tips: You might see the 87260 family described as “DFA,” which stands for direct fluorescence assay; and you might see the 87301 family called “EIA,” which is the abbreviation for enzyme immunoassay. Clinicians might call a test from the 87470 family a “DNA probe,” “RNA probe,” or “nucleic acid probe.” The 87802 family involves a visual observation, such as color change, and might be called an “optical immunoassay.”

Don’t miss: If the lab performs a nucleic acid probe test for infectious agent antigen detection, you’ll have three choices, in many cases: direct probe, amplified probe, or quantification.

Tip 3: Find the Organism

Once you’ve located the proper code family based on the lab method for an infectious agent antigen detection test on a direct-source specimen, you have to know the specific organism name to find the right code. 

CPT® lists the organisms in alphabetical order under the parent code. For example, after parent code 87260 for adenovirus, you will see listings for 87265 (... Bordetella pertussis/parapertussis) in alphabetical order through 87290 (... Varicella zoster virus). 

Coder tip: You’ll have to look line by line for the infectious agent within the proper method family because you won’t always find these codes by looking up the organism in the CPT® index.

Each method-based code family lists specific tests by organism name, but the list is different within each family. That’s because there’s not a lab test for every organism by every method. 

Watch out: Although the list of organisms under each parent code is not the same, some organisms do appear under each method, and you’ll need to make sure you’re looking in the correct code family if you want to pick the right code. 

For instance: You’ll find six infectious agent antigen detection codes for Chlamydia trachomatis (87270, 87320, 87490, 87491, 87492, 87810).

Tip 4: Do This if You Can’t Find the Organism 

When your lab uses a specific method (such as EIA) but the organism you’re testing isn’t listed by that method, don’t choose a different-method code for that organism. Instead, you’ll need to use the “not otherwise specified” (NOS) code for the lab method that you use. In other words, you’re testing for an NOS organism within the specific lab method.

Here are the general codes for unlisted organisms under each method:

• 87299 — Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism
• 87449 — Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism 
• 87450 — ... single step method, not otherwise specified, each organism 
• 87797 — Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism
• 87798 — ... amplified probe technique, each organism 
• 87799 — ... quantification, each organism 
• 87899 — Infectious agent detection by immunoassay with direct optical observation; not otherwise specified.

Remember: Even if CPT® lists the organism under a different lab method, you have to assign the “not otherwise specified” code based on the technique the lab carried out.

Tip 5: Avoid Multiple Codes for a Single, Multiple-Organism Test 

If your lab tests for multiple infectious agent antigens using a single test, you shouldn’t use the preceding codes. Instead, CPT® provides specific codes for lab methods that detect multiple organisms with one test, as follows:

• 87300 — Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum 
• 87451 — Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, polyvalent for multiple organisms, each polyvalent antiserum 
• 87800 — Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique 
• 87801 — ... amplified probe(s) technique.

For example: If the lab performs a direct-probe test that screens for gonorrhea and Chlamydia, you should report 87800, not 87490 (... Chlamydia trachomatis, direct probe technique) and 87590 (... Neisseria gonorrhoeae, direct probe technique).