Pathology/Lab Coding Alert

Question: Our lab tests a bronchial lavage specimen for respiratory viruses by multiplex amplified probe technique and identifies two influenza virus subtypes and three adenovirus subtypes. Should we report 87502 and 87631? 

Texas Subscriber

Answer: No, you should not report together 87631 (Infectious agent detection by nucleic acid [DNA or RNA]; respiratory virus [e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus], multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets) and 87502 (Infectious agent detection by nucleic acid [DNA or RNA]; influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types) for the same specimen. 

Instead, you should report the single code that most accurately describes the test you performed, which is 87631.

New codes: CPT® 2013 adds three new codes for respiratory virus detection, distinguished by the number of type or subtype targets: 87631, 87632 (…6-11 targets), and 87633 (…12-25 targets).

These codes describe multiplex tests for any or all of the respiratory viruses. CPT® also provides separate codes for the individual virus types by similar methodology. 

Principle: You should select the single, most-specific code that describes the virus and method for a single specimen and test.  

Correct Coding Initiative (CCI) 19.0 confirms this principle by bundling each of the new codes (87631-87633) with the following specific respiratory virus tests.

• 87275 — influenza B virus
• 87276 — influenza A virus
• 87279 — parainfluenza virus, each type
• 87280 — respiratory syncytial virus
• 87301 — Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; adenovirus enteric types 40/41
• 87400 — influenza, A or B, each
• 87501 — Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype
• 87502 — influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types
• 87503 — influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure)
• 87801 —  Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
• 87260 —  Infectious agent antigen detection by immunofluorescent technique; adenovirus.

CCI assigns a modifier indicator of “0” to many of these edit pairs, meaning that you can’t unbundle the codes under any circumstances.