Pathology/Lab Coding Alert

Question: I’m new to lab coding; could you help me understand how to report a blood test from a transplant patient for CMV?

Oklahoma Subscriber

Answer: Labs perform many different blood tests to help evaluate patient infection with cytomegalovirus (CMV). The tests vary according to lab method used, as well as what information the clinician is seeking. Labs may test for presence or absence of the infectious agent (qualitative antigen test), the viral load (quantitative antigen test), or prior infection with the organism (antibody test).

Your question doesn’t provide enough information to assign a specific CPT^® code. However, you may be able to select one of the following codes once you gather more specific information:

• 87495 (Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct probe technique)
• 87496 (… cytomegalovirus, amplified probe technique)
• 87497 (… cytomegalovirus, quantification)
• 87271 (Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA))
• 87332 (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; cytomegalovirus)
• 86644 (Antibody; cytomegalovirus (CMV))
• 86645 (… cytomegalovirus (CMV), IgM)

Transplant: Because CMV is a common opportunistic infectious agent in organ transplant patients, clinicians typically want a quantitative test to confirm CMV infection and determine the viral load. This information can help the clinician determine the likelihood of tissue-invasive infection and guide the choice of antiviral therapy.

To provide that sort of information, the lab is likely to quantify CMV levels using a process such as polymerase chain reaction (PCR) of target CMV DNA in the patient specimen performed on a molecular system analyzer. If you find documentation for that sort of CMV testing, an appropriate code would be 87497.