Good morning,
We are also having this same issue. I have been looking all through our CPT books and looking through policies to see what has changed all of a sudden. Have you had any luck in finding any information regarding this change? Any help you could provide I would be extremely grateful!
This was my response to Ashely:
Hi Ashley. My usual resource site is down and they are not telling me when it will come back up so I can't do my usual checking on this, but... The code you are using would normally be correct as they are specific CPT codes for each organism being testing with the Affirm test kit, but the problem is that only 1 test kit is used to test for all three. But some have suggested using either 87800 or 87797 for the Affirm III. However, back in 2016, The CPT Assistant stated the following: "Code is 87800 is reported when the organisms are not differentiated by the assay, and therefore, one result is obtained for all organisms tested. If the result is positive, the positive organism(s) cannot be determined. Code 87797 is reported when the assay does differentiate the organisms, and therefore, a separate result is obtained for each organism tested. For example, if three organisms are tested, three results are obtained. The microbiology guidelines in the CPT 2016 code set state that “[w]hen separate results are reported for different species or strain of organisms, each result should be coded separately.”
Given that, 87797 may be the code they are expecting, but on the other hand, what is your denial message? The codes you are using are all valid, but sometimes it is the
diagnosis code that gets them denied. For instance, Affirm is generally not paid with a screening diagnosis, but can be paid with codes like N76.0-N76,3, N77.1, and N98.8. If doing the test on a pregnant woman, it would not be covered for routine screening for preterm birth, but generally only when code O23.00-O23.93 are designated. I hope this helps.
