Pathology/Lab Coding Alert

Don’t forget what the # symbol means in CPT^®.

When you’re searching for the correct test descriptor from more than 100 CPT^® infectious agent antigen detection codes, many pitfalls await. Fortunately, help is here to break down the 87260-87899 code range and spotlight accurate reporting for pathogen-specific lab tests.

Remember: You use codes 87260-87899 only for primary-source specimens, such as blood or urine, not for microbiology cultures. The tests describe procedures to detect the presence of an organism-specific antigen, not an antibody. Separate CPT^® codes describe procedures to identify infection based on a lab culture or a lab test for an antibody produced by the body in response to a pathogen.

Tip 1: Focus on Lab Technique

Once you establish that the test you’re reporting is for antigen detection from a primary source, you need to know what laboratory technique the test uses. CPT^® subdivides the codes into families based on lab method, with the parent code providing the common descriptor preceding the semicolon, as follows:

• 87260 (Infectious agent antigen detection by immunofluorescent technique; adenovirus).
  You may see this method described as a direct fluorescent antibody (DFA) test.
• 87301 (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; adenovirus enteric types 40/41)
• 87468 (Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe technique). Notice that you’ll often see two or three nucleic acid test codes for the same organism described as “direct probe technique,” “amplified probe technique,” or “quantification.”
• 87802 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B). Labs may describe these tests as “optical immunoassay.” The key for these codes is that the lab makes the determination based on some visual observation, such as a color change.

Tip 2: Find Organism Name in Lab-Method Family

For each of the four code families grouped by lab method described in Tip 1, you’ll find codes for specific organisms. CPT^® lists the organisms in alphabetical order under the parent code. For instance, codes in the 87260 family go from adenovirus (87260) to varicella zoster virus (87290).

Caution: Although the codes are in alphabetical order by organism within each family, they may not be in numerical order. That’s because, to avoid renumbering entire code lists, CPT^® now inserts newly added code numbers where they belong categorically and identifies the numerically out-of-sequence code with the hashtag symbol (#). For instance, CPT^® lists code #87811 (… severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])) alphabetically between 87807 (… respiratory syncytial virus) and 87808 (… Trichomonas vaginalis).

Hint: You may need to hunt line-by-line for an organism within the proper lab-method code family, because you won’t always find the information in the index. Also, you will find some, but not all, organisms listed under multiple code families (such as chlamydia trachomatis in each family: 87270, 87320, 87490, 87491, 87492, 87810).

Avoid: If you don’t find the organism listed under the method the lab uses, don’t use a code for the organism from a different lab-method family. Instead, look at the following tip to learn how to manage the situation.

Tip 3: Report Method Code for Unlisted Infectious Agent

When you know the technique the lab uses, but the specific infectious agent isn’t listed in that code family, you’ll have to report the general method code for the lab test. That’s when you should turn to one of the following “not otherwise specified” (NOS) codes:

• 87299 (Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism)
• 87449 (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; not otherwise specified, each organism)
• 87797 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism)
• 87798 (… amplified probe technique, each organism)
• 87799 (… quantification, each organism)
• 87899 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified)

Tip 4: Turn to Special Codes for Multiple Organisms

If the lab performs a single test for detection of multiple infectious agent antigens, you need to look to alternate codes.

Specific: CPT^® provides a few codes for specific groups of organisms, such as the following:

• 87400 (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; Influenza, A or B, each)
• 87428 (… severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B)
• 87637 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique)

Category: You’ll also find codes that describe testing for multiple infectious agents that might be associated with a specific body system, such as respiratory or gastrointestinal organisms. Look at these codes, for example:

• 87483 (Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets)
• 87505 (… gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets)
• 87506 (… 6-11 targets)
• 87507 (… 12-25 targets)
• 87631 (… respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets)
• 87632 (… 6-11 targets)
• 87633 (… 12-25 targets)

Note: The above codes describe single tests that provide multiple distinct results for multiple organisms.

Unlisted: If the lab performs a single test for multiple organisms other than the preceding codes, you’ll also have the following codes to turn to:

• 87300 (Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum)
• 87451 (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; polyvalent for multiple organisms, each polyvalent antiserum)
• 87800 (Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique)
• 87801 (… amplified probe(s) technique)

Note: Codes 87800 and 87801 describe a single test for multiple organisms that report a single result, not multiple results for specific organisms. Similarly, 87300 and 87451 describe tests that report a single result for a single polyvalent antiserum (that is, a single finding for multiple antigens assessed).

Tip 5: Don’t Miss PLA Codes

CPT^® lists several Proprietary Laboratory Analyses (PLA) codes that describe testing for infectious agent antigen detection, such as the following:

• 0321U (Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogens, identification of 20 bacterial and fungal organisms and identification of 16 associated antibiotic-resistance genes, multiplex amplified probe technique)
• 0402U (Infectious agent (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, multiplex amplified probe technique, vaginal, endocervical, or male urine, each pathogen reported as detected or not detected)

Imperative: PLA codes apply to only one unique lab test made by a specific manufacturer or performed by a specific lab. PLA codes take precedence over the usual 80000 series codes for laboratory/pathology, so you must report the appropriate PLA code if you perform the proprietary test.

Ellen Garver, BS, BA, Contributing Writer