CPT® Code 87153

Official Description

Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)

Common Language Description

The CPT® Code 87153 refers to a specialized laboratory procedure known as culture typing, which involves the identification of microorganisms through nucleic acid sequencing methods. This process is crucial in microbiology for differentiating closely related organisms based on their genetic material. Nucleic acids, which include DNA and RNA, are analyzed to determine the specific sequence of nucleotide bases that make up the genetic code of an organism. This sequencing is particularly valuable for rapidly identifying pathogens, such as distinguishing Bacillus anthracis, the causative agent of anthrax, from other similar spore-forming Bacillus species like B. cereus and B. thuringiensis. The procedure utilizes advanced technologies, including automated sequencing systems and DNA alignment software, to enhance accuracy and efficiency. Initially, the DNA of the organism is amplified using techniques such as polymerase chain reaction (PCR), which increases the quantity of DNA available for analysis. Following amplification, the DNA is sequenced using specific primers designed to target particular regions of the genetic material. For instance, the sequencing of the 16S rRNA gene, which is a common target for bacterial identification, requires the use of 16 different primers. A sequencing kit is employed to facilitate this process, and the resulting sequencing products undergo purification using specialized equipment to ensure the accuracy of the results. The purified DNA is then analyzed using an automated DNA sequencing system, which reads the nucleotide sequences. The length of the sequences obtained may vary depending on the specific primers utilized during the sequencing process. Ultimately, this detailed analysis allows for the precise identification of the organism in question, including the potential discovery of new or novel types of the organism, thereby contributing significantly to the field of microbiology and infectious disease diagnostics.

1. Indications

The procedure associated with CPT® Code 87153 is indicated for the identification of specific microorganisms through nucleic acid sequencing. The following conditions and scenarios warrant the use of this procedure:

Identification of Pathogens: This procedure is performed to accurately identify pathogenic organisms, particularly in cases where rapid differentiation from closely related species is critical.
Diagnosis of Anthrax: It is specifically indicated for the rapid identification of Bacillus anthracis, the bacterium responsible for anthrax, especially in clinical or environmental samples.
Investigation of Outbreaks: The procedure is useful in epidemiological investigations to trace and identify sources of infection during outbreaks of diseases caused by similar organisms.
Research Applications: It is also indicated in research settings for the identification of novel or previously uncharacterized strains of bacteria.

2. Procedure

The procedure for CPT® Code 87153 involves several critical steps to ensure accurate identification of the microorganism through nucleic acid sequencing. The following steps outline the process:

Step 1: Sample Collection - A sample containing the microorganism of interest is collected from a patient or environmental source. This sample may include bodily fluids, tissue, or environmental specimens.
Step 2: DNA Amplification - The DNA from the collected sample is amplified using polymerase chain reaction (PCR). This technique increases the quantity of DNA, making it sufficient for sequencing analysis.
Step 3: Primer Selection - Specific primers are selected for the sequencing process. For the identification of Bacillus anthracis, 16 different primers targeting the 16S rRNA gene are utilized to ensure comprehensive coverage of the genetic material.
Step 4: Sequencing - The amplified DNA is sequenced using the selected primers. This step involves the use of a sequencing kit and automated sequencing systems to accurately read the nucleotide sequences of the DNA.
Step 5: Purification of Sequencing Products - After sequencing, the products are purified using specialized equipment to remove any contaminants and ensure the integrity of the sequencing results.
Step 6: Data Analysis - The purified sequencing products are analyzed to determine the length and sequence of the DNA fragments. This analysis allows for the identification of the specific organism present in the sample.
Step 7: Identification of Organism - The final step involves comparing the obtained sequences against known databases to accurately identify the microorganism, including the potential discovery of new or novel strains.

3. Post-Procedure

Post-procedure care for CPT® Code 87153 primarily involves the interpretation of the sequencing results and the communication of findings to the requesting physician or healthcare provider. The results may require further clinical correlation to determine the appropriate course of action based on the identified organism. In cases where a pathogenic organism is identified, additional measures may be taken to manage the infection, including treatment options and public health notifications if necessary. It is also important to document the findings thoroughly in the patient's medical record for future reference and continuity of care.

Short Descr	DNA/RNA SEQUENCING
Medium Descr	CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE
Long Descr	Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	No
APC Status Indicator	Conditionally packaged laboratory tests
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	3
CCS Clinical Classification	206 - Microscopic examination (bacterial smear, culture, toxicology)

90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
91	Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
X5	Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician