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CPT CODES, PARASITOLOGY, REV. 2007

 

PROCEDURE NAME

CPT

Blood Film (Thick), Blood film stain (includes concentration)

87015 + 87207

Blood Film (Thin), Blood film stain

87207

Calcofluor Stain (direct material, no concentration)

87206

Culture (Acanthamoeba) (Agar plates) (Screen, Wet Mt, Permanent Stain) (Trichrome, use 87209)

87081 + 87210 + 87207 (Giemsa)

Culture (Intestinal and Blood Protozoa) (Culture, Conc, Wet Mt, Permanent Stain of culture sediment)

 

87081 + 87215 + 87210 + 87207 (Giemsa) or 87209 (Trichrome)

Culture, Agar Plate (Strongyloides)

87081 + 87210

Culture (Trichomonas) (Pouch) (Screen) (Microscope exam through plastic pouch)

87081

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

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 + 87269

Cryptosporidium/Giardia Examination (EIA)

(Screen that detects both, but does not differentiate between the two.) If positive, separate reagents must be used.

87328 + 87329 (Neg)

Cryptosporidium/Giardia/E. histo/E. dispar group, cartridge

87328 + 87329 + 87336

Cyclospora Examination (Mod AFB) (concentrate sediment)

87015 + 87207

Cyclospora Examination (Autofluorescence) (conc. sediment)

87015 + 87210

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: trichrome)

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 prep/stain separate codes)

85032

Plasmodium (Rapid Tests – dipstick, etc.)  Infectious agent antigen detection by immunoassay with direct optical observation, not otherwise specified

87899*

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, Antigen 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).

KEY POINT

 

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.

 

CPT CODES, PARASITOLOGY, REVISION 2007 (Immunology, Antibody Testing)

 

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

Counterimmunoelectrophoresis, each antigen (Ex:  Entamoeba histolytica)

86185

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