Pathology/Lab Coding Alert

Reader Questions:

Focus Correct SARS-CoV-2 Antibody Code

Published on Mon May 10, 2021

Question: Our physician office lab has started using a rapid test to detect SARS antibodies in a patient nasal swab specimen to help determine if the patient has had COVID-19. Can we bill for the test, and if so, how should we code the test?

Mississippi Subscriber

Answer: If your physician office operates a lab with a certificate of waiver under the Clinical Laboratory Improvement Amendments (CLIA), then yes, you can bill for the test.

CPT^® now provides several Category I and Proprietary Laboratory Analyses (PLA) codes related to testing for SARS-CoV-2, so it’s hard to know exactly what test you’re using to be able to give a definitive answer regarding the correct code.

However, based on your description, it appears that the best choice is 87426 (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])).

The test involves using a nasal swab processed with a reagent that releases viral nucleoprotein antigen, if present, reacted with target antibodies for an immunoassay that identifies the presence of a SARS coronavirus such as SARS- CoV or SARS-CoV-2. This is a rapid test of low complexity, so it is a CLIA-waived test. As such, Centers for Medicare and Medicaid Services (CMS) has instructed that “to be recognized as a test that can be performed in a facility possessing a CLIA certificate of waiver, the modifier QW (CLIA waived test) must be added (87426QW).”