Pathology/Lab Coding Alert
Report Unit of Service per Test
Question: We perform a single PCR test that can identify and distinguish between Bartonella henselae and Bartonella quintana. Can we report two units of the test code for the two organisms?
Florida Subscriber
Answer: The appropriate code for the polymerase chain reaction (PCR) nucleic acid probe test you describe is 87471 (Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique).
No, you should not bill two units of 87471 for a single test that can identify both organisms. CPT® coding principals dictate using just one code for a single test, plus the National Correct Coding Initiative (CCI) Policy Manual provides instructions for this and other infectious agent antigen detection codes as follows:
“If a single [infectious agent detection] test procedure produces results for multiple species or strains of an organism, only one (1) unit of service (UOS) of a CPT® code may be reported for that test procedure.”
Difference: On the other hand, if your lab must run two separate tests to test for different strains of an organism, you can bill multiple units of a code. The manual has this to say, “… if separate medically reasonable and necessary test procedures are performed for different species or strains of an organism, the same CPT® code may be reported for each test procedure utilizing modifier 59 (Distinct procedural service) for the second and additional test procedures.
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