Wiki Clarification on CPT 87500

[HaziqM]

When reporting CPT Code 87500 for Vancomycin resistance (Van A and Van B), please confirm in which scenarios we can bill CPT code 87500:

• If Enterococcus species (Enterococcus faecalis, Enterococcus faecium or Enterococcus cocci) are tested but not detected and Van A or Van B is tested but not detected in the panel?
• If any one of the Enterococcus species (Enterococcus faecalis, Enterococcus faecium or Enterococcus cocci) is detected and Van A or Van B tested but not detected in the panel?
• If any one of the Enterococcus species (Enterococcus faecalis, Enterococcus faecium or Enterococcus cocci) are detected and Van A or Van b is detected?

 

[melissa0829]

There are so many different infectious agent tests available, without knowing the actual test being performed and seeing the methodology it would be hard to answer the questions you are asking with just a yes or no response, but I will share what I know regarding 87500 and Infectious Agent Panel tests.

Code 87500 is used when performing nucleic acid detection test for the detection on nucleic acid sequence S responsible for resistance for van A and van B, not the organism itself. In the code description notice the eg, before enterococcus species van A, van B, the eg, in the code description is only an example of a potential organism, not an inclusive list of organisms associated with van A and van B resistance.

Is the test performed by identifying van A and van B genes by detecting nucleic acid sequence S? The answer should be specified in the testing methodology. I would look for something like 'testing organisms from clinical specimens with DNA amplified probe tests identify vancomycin resistance genes such as van A and van B' or 'the test detects nucleic acid sequence S associated with van A and van B genes, by amplified probe technique.' These are just examples I'm familiar with, I'm sure there are many more.

In two of the bullet-points you mention "in the panel" is this one test using one assay or one test kit? And are multiple pathogens being tested in the 'panel'? If you answer yes to both questions, you could be unbundling by billing individual codes to represent the one panel/test kit. Check NCCI Policy Manual Chapter 10 Section K and Section M. Also, if you bill Medicare for the service be sure to look at the LCDs and billing articles. Both provide a wealth of knowledge around infectious agent testing and the definition of "Panel."

*Information taken from a collaboration of resources from AAPC, Optum, CMS.gov and MedLearn.

I hope this information is helpful.

Melissa Lambert RN, CPC-I, CPMA, CPB, CDEO, CRC, CPC