Pathology/Lab Coding Alert

Question: The lab receives a blood specimen with a request for a test to “rule out histoplasmosis” for a patient who works a farm in the Ohio Valley and presents with prolonged fever, tiredness, headache, and body aches. How should we report the test?

Tennessee Subscriber

Answer: The answer depends on the type of test the lab performs. The most common test is an infectious agent antigen detection test, 87385 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Histoplasma capsulatum).

The lab may perform an antibody test, however, to help investigate if there is active infection with the organism. Report the antibody test as  (Antibody; Histoplasma).

CPT^® provides a third code for histoplasmosis testing, but it involves a skin test rather than evaluating a blood specimen (86510, Skin test; histoplasmosis).

Histoplasmosis is caused by infection with the fungus Histoplasma capsulatum. The fungus lives in soil throughout the United States, especially around the Ohio and Mississippi River valley regions, and human infection can begin by breathing fungal spores in the air. The patient may experience flu like symptoms such as fever, tiredness, headache, and body aches that generally resolve within a month. However, in some patients with a weakened immune system, histoplasmosis may develop into an ongoing lung infection or, rarely, a brain or spinal cord infection.