Pathology/Lab Coding Alert

Question: Should we bill the Chlamydia and gonorrhea screening in pregnancy using 87490 and 87590, or 87800? Because the directions state we should report the most specific code possible, do we have to use the codes that name the organisms (87590 and 87490)? Oregon Subscriber Answer: The codes you mention are for infectious agent detection from a primary source rather than a culture. You select the appropriate code based on the test method and the organism identified. Although CPTdirections state that "the most specific code possible should be reported," that includes specificity for method and organism.

There are several codes for Chlamydia and gonorrhea from a primary source:
  87270 Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
87320 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis
87490 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
87491 Chlamydia trachomatis, amplified probe technique
87492 Chlamydia trachomatis, quantification
87590 Neisseria gonorrhoeae, direct probe technique
87591 Neisseria gonorrhoeae, amplified probe technique
87592 Neisseria gonorrhoeae, quantification
87810 Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis
87850 Neisseria gonorrhoeae. You must know the lab method used to select the correct code. Based on your question, the lab method appears to be direct probe technique, which would point to 87490 and 87590 from this list. Those are the appropriate codes if your lab performed two separate direct probe tests, one for gonorrhea and one for Chlamydia. But if the lab uses one of the newer tests available that screen for both of these organisms at once, even if it is by direct probe technique, you should not use the individual codes for the tests. In that case, the more specific code is 87800 (Infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; direct probe[s] technique). Although this code does not list the organisms you're testing for, it more specifically describes the procedure, which is a multiple organism screening by direct probe(s).

Some of the new screenings for gonorrhea and Chlamydia also use gene amplification to make the probe test more sensitive. If your lab uses one of those tests, report 87801 ( amplified probe[s] technique).