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Official Description

Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 87220 refers to a diagnostic procedure known as tissue examination by KOH slide, specifically targeting samples obtained from skin, hair, or nails. This examination is performed to identify the presence of fungi or ectoparasite ova or mites, such as those responsible for scabies. In this procedure, a sample of the affected tissue is prepared on a wet slide, which may or may not include the application of a fluorescent dye. The prepared slide is then examined under a microscope, allowing for the detailed observation of any fungal elements, eggs of parasites, or mites that may be present. Mites, in particular, are small parasitic insects that can cause various skin conditions, and their identification is crucial for accurate diagnosis and treatment. This procedure is essential in dermatology and other medical fields where skin, hair, and nail infections or infestations are suspected.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 87220 is indicated for the evaluation of various dermatological conditions where fungal infections or ectoparasitic infestations are suspected. The following are specific indications for performing this examination:

  • Fungal Infections The procedure is utilized to diagnose fungal infections affecting the skin, hair, or nails, which may present with symptoms such as itching, redness, or scaling.
  • Scabies This examination is particularly important for identifying scabies, a condition caused by the infestation of the skin by the Sarcoptes scabiei mite, leading to intense itching and rash.
  • Other Ectoparasitic Infestations The procedure can also be indicated for the detection of other ectoparasites that may affect the skin, hair, or nails, contributing to various dermatological symptoms.

2. Procedure

The procedure for CPT® Code 87220 involves several key steps to ensure accurate examination and diagnosis. Each step is critical for the successful identification of fungi or ectoparasites.

  • Sample Collection The first step involves the careful collection of a sample from the affected area, which may include skin, hair, or nails. This sample should be representative of the area showing signs of infection or infestation.
  • Preparation of the Slide Once the sample is collected, it is placed on a glass slide. A potassium hydroxide (KOH) solution may be added to the sample to clear the tissue, making it easier to visualize fungal elements or parasites under the microscope. In some cases, a fluorescent dye may also be applied to enhance visibility.
  • Microscopic Examination The prepared slide is then examined under a microscope. The healthcare professional will look for the presence of fungal hyphae, spores, or ectoparasite ova and mites. This examination requires expertise to accurately identify the various structures associated with fungal infections or parasitic infestations.

3. Post-Procedure

After the completion of the KOH slide examination, the healthcare provider will interpret the findings and may discuss the results with the patient. If fungi or ectoparasites are identified, appropriate treatment options will be considered based on the specific diagnosis. Patients may be advised on follow-up care, which could include additional testing or treatment regimens. It is important for patients to monitor their symptoms and report any changes to their healthcare provider, as this can influence the management plan. Additionally, proper hygiene and care of the affected area may be recommended to prevent further infection or infestation.

Short Descr TISSUE EXAM FOR FUNGI
Medium Descr TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
Long Descr Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)
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.
GC This service has been performed in part by a resident under the direction of a teaching physician
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ Item or service expected to be denied as not reasonable and necessary
HO Masters degree level
KX Requirements specified in the medical policy have been met
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q4 Service for ordering/referring physician qualifies as a service exemption
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QW Clia waived test
SA Nurse practitioner rendering service in collaboration with a physician
TA Left foot, great toe
X3 Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2001-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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