Pathology/Lab Coding Alert

Question: The lab evaluates a swab from a skin lesion for Staphylococcus aureus, Streptococcus group A, and Bartonella species henselae and quintana using amplified probe nucleic acid testing. The lab reports the findings as positive for S. aureus, and negative for Strep A and Bartonella spp. Should we report the test as 87801 because it’s multiple organisms?

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Answer: Because the test provides a separate result for each specific organism, you know that the test includes evaluation for infection with each individual organism. That means you should not report the service as 87801 (Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique). Reserve 87801 for a single test that results in a single finding of positive or negative for infection with one of the organisms tested, without positively differentiating between organisms.

Instead, you should code the case as 87471 (Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique), 87640 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique), and 87651 (Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique).

CPT^® provides a text note following 87801 that states, “For each specific organism nucleic acid detection from a primary source, see 87471-87660,” which is the code range that includes the specific codes listed above.

Also, CPT^® Assistant, June 2013; Volume 23: Issue 6, provides an example involving different organisms that states, “If the test results differentiate between [the organisms] then it would be appropriate to report [the individual organism codes]. If the results do not differentiate, then it would be appropriate to report code 87801.”