PROCEDURE NAME |
CPT |
Blood Film (Thick), Blood film stain (includes concentration) |
87015 + 87207 |
Blood Film (Thin), Blood film stain |
87207 |
Buffy Coat Blood Film (Thick) Blood film stain (includes conc.) |
87015 + 87207 |
Buffy Coat Blood Film (Thin) Blood film stain (includes conc.) |
87015 +87207 |
Calcofluor Stain (direct material, no concentration) |
87206 |
Calcofluor Stain (Concentrated material) |
87015 + 87206 |
Concentration, Baermann (Plus Wet Mount Examination) |
87015 + 87210 |
Concentration, Blood (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier) (will include Knott and Membrane Concentrations using Nuclepore filters) |
87015 + 87210 |
Concentration, Harada-Mori (Plus Wet Mount Examination) |
87015 + 87210 |
Concentration, Iodine Prep (Wet Prep Only) |
87015 + 87210 |
Concentration (Misc) |
87015 |
Concentration, Petri Dish (Plus Wet Mount Examination) |
87015 + 87210 |
Concentration, Saline Prep (Wet Prep Only) |
87015 + 87210 |
Counterimmunoelectrophoresis, each antigen (Ex: Entamoeba histolytica) |
86185 |
Cryptosporidium Examination (Mod AFB) (Conc. Sediment) |
87015 + 87207 |
Cryptosporidium Examination (FA) (Conc. Sediment) |
87015 + 87272 |
Cryptosporidium Examination (EIA) (Plate/tray) |
87328 |
Cryptosporidium Examination (Cartridge) |
87328* |
Cryptosporidium/Giardia Examination (FA) (Conc. Sediment) |
87015 + 87272 + |
Cryptosporidium/Giardia Examination (EIA) |
87328 + 87329 |
Cryptosporidium/Giardia/E. histo/E. dispar group, cartridge |
87328 + 87329 + |
Cyclospora Examination (Mod AFB) (concentrate sediment) |
87015 + 87207 |
Cyclospora Examination (Autofluorescence) (conc. sediment) |
87015 + 87210 |
Culture (Acanthamoeba) (Agar plates) (Screen, Wet Mt, Permanent Stain) (Trichrome, use 87209) |
87081 + 87210 + |
Culture (Intestinal and Blood Protozoa) (Culture, Conc., Wet Mt, Permanent Stain of culture sediment) |
87081 + 87215 + |
Culture, Agar Plate (Strongyloides) |
87081 + 87210 |
Culture (Trichomonas) (Pouch) (Screen) (Microscope exam through plastic pouch) |
87081 |
Ectoparasite Identification (Macro) (Arthropod) |
87168 |
Ectoparasite Identification (Wet Mt) (Arthropod) |
87210 |
Ectoparasite Identification (Skin, Scabies) |
87220 |
Entamoeba histolytica/E dispar Group (EIA) |
87336 |
Entamoeba histolytica (EIA) |
87337 |
Examination, Wet Prep Only (Wet Prep Only) |
87210 |
Examination, Duodenum (Conc, Wet Mts) |
87177 |
Examination, Duodenum (Permanent Stain) |
87209 |
Examination, EnteroTest (Wet Mts Only) |
87210 |
Examination, EnteroTest (Permanent Stain Only) |
87209 |
Examination, urine (Random) (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier) |
87015 + 87210 |
Examination, 24 h Urine (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier) |
87015 + 87210 |
Fat, Stool (Qualitative) |
82705 |
Giardia Examination (FA) (Conc. Sediment) |
87015 + 87269 |
Giardia Examination (EIA) (Plate/Tray) |
87329 |
Giardia Examination (Cartridge) |
87329* |
Helminth Egg Hatching (Concentration, Wet Mounts) |
87177 |
Isospora Examination (Mod AFB) (conc. sediment) |
87015 + 87207 |
Leishmania lesion, stained smear |
87207 |
Microsporidia, Special Stain (Modified Trichrome) (on concentration sediment) |
87015 + 87207 |
Microsporidia, Fluorescent Stain (Calcofluor) (on concentration sediment) |
87015 + 87206 |
Occult Blood, Stool |
82270 |
Occult Blood, Gastric |
82273 |
Ova and Parasite Examination (Direct Smears, Concentration and Smears) (Also recommended for Concentration and Wet Mts) |
87177 |
Ova and Parasite Examination (Permanent Stain) (Ex: |
87209 |
Ova and Parasite Examination (Complete Examination) (Direct Smears, Concentration, Permanent Stain) |
87177 + 87209 |
|
|
Petri Dish Culture/Concentration (Plus Examination) |
87015 + 87210 |
pH, Body fluid except blood (Stool) |
83986 |
Pinworm Examination, Cellophane Tape |
87172 |
Plasmodium (Parasitemia Determination) Manual cell count (RBC, WBC OR Platelet) each (slide preparation and stain - add separate codes) |
85032 |
Plasmodium (Rapid Tests – dipstick, etc.) Infectious agent antigen detection by immunoassay with direct optical |
87899 *x 3 |
Reducing Substances, Stool (pH) |
83986 |
Referral In (Stool for Ova & Parasite Exam) |
87177 + 87209 |
Tissue homogenization for culture |
87176 |
Trichomonas vaginalis, direct probe (Ex: Affirm) |
87660 |
Trichomonas vaginalis, detection immunoassay with direct optical observation (Ex: Osom) |
87808 |
Trypsin Activity, Stool (Qualitative) |
84488 |
Worm Identification (Macro) |
87169 |
Worm Identification (Wet Mt) |
87210 |
*Because there is no analyte code for Cryptosporidium or Giardia for “immunoassay with direct optical observation” (cartridges) – it is appropriate to use the analyte specific code for EIA for the two organisms (for cartridge formats). Since there is a specific code for Trichomonas “immunoassay with direct optical observation” – this number should be used. In the coding hierarchy, analyte comes before method. In the case of the rapid Plasmodium tests (dipsticks, cartridges), there is no analyte listed for EIA, so in these cases we need to use the nonspecific code: “Infectious agent antigen detection by immunoassay with direct optical observation, not otherwise specified” (87899).
NOTE: When using FA reagents or special stains for the coccidia or microsporidia, you should always perform these tests on centrifuged material, thus the need to add the concentration code 87015.
For multiple specimens/sites/patient/day use modifier ‘-91’
Example: blood for malaria (receipt of more than one specimen/patient/day). This is a repeat of the same test to increase analytical sensitivity
For repeat laboratory tests performed on the same day/patient, use modifier ‘-91’.
Example: multiple wet preparation exams for duodenal aspirate (examination of more than one wet preparation from a single specimen/patient/day).
For multiple stool specimens collected on different days, but submitted to the laboratory on one day: code for separate dates (no modifier required).
When considering a potential audit situation, remember that THE TEST CPT
CODES AND BILLS SHOULD MATCH THE SAME TESTS AND BILLS FOR
THE TESTS THE PHYSICIAN ORDERED. THEREFORE, IT IS CRITICAL
THAT YOUR REQUISITION FORMS AND/OR COMPUTER ORDER SCREENS MATCH WHAT YOU ARE ACTUALLY CODING AND BILLING. This is now an issue since Giardia and Cryptosporidium (FA, EIA) have now been broken out and should be coded and billed as separate tests.
PROCEDURE NAME |
CPT |
Antibody Detection |
|
Giardia lamblia |
86674 |
Helminth, not elsewhere specified |
86682 |
Leishmania |
86717 |
Plasmodium |
86750 |
Protozoa, not elsewhere specified (Ex: Entamoeba histolytica) |
86753 |
Toxoplasma |
86777 |
Toxoplasma, IgM |
86778 |
Trichinella |
86784 |
Complement Fixation |
|
Echinococcosis |
86171 |
Trypanosomiasis |
86171 |
Hemagglutination Inhibition Test (HAI) |
|
Echinococcosis |
86280 |
Filariasis |
86280 |
Trypanosomiasis |
86280 |
Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg. Reagent strip) |
86318 |