CPT® Code 87278

Official Description

Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila

Common Language Description

The CPT® Code 87278 refers to a laboratory test specifically designed for the detection of the antigen of the bacterium Legionella pneumophila using an immunofluorescent technique. This test is crucial for identifying the presence of Legionella pneumophila, which is the causative agent of Legionnaire’s Disease, a severe form of pneumonia that manifests with symptoms such as cough, dyspnea (difficulty breathing), fever, body aches, and headache. Additionally, this bacterium is responsible for Pontiac Fever, a milder illness that resembles influenza and is characterized primarily by fever and body aches without the pneumonia symptoms. Legionella pneumophila is commonly found in various freshwater environments, including lakes, streams, and man-made water systems such as showers, faucets, cooling towers, hot tubs, decorative fountains, and plumbing systems. Infection typically occurs when individuals inhale or aspirate small droplets of water that contain the bacterium, making it a significant concern in settings where water systems are not properly maintained. The test involves obtaining a sample from lung tissue, pleural fluid, pericardial fluid, nasopharyngeal or bronchial washings, or sputum. This sample is then treated with a detecting reagent that contains antibodies specific to Legionella pneumophila, along with a counterstain. The prepared sample is examined under an epifluorescence microscope, where the presence of Legionella pneumophila can be confirmed by a distinct color change resulting from the binding of antibodies to the antigens of the bacterium. While this immunofluorescent test offers a rapid detection method, it is important to note that it may be less sensitive compared to traditional culture methods and reverse transcription-polymerase chain reaction (RT-PCR) techniques.

1. Indications

The CPT® Code 87278 is indicated for use in the detection of the Legionella pneumophila bacterium in various clinical scenarios. The following conditions and symptoms warrant the performance of this test:

Legionnaire’s Disease - This acute type of pneumonia is characterized by symptoms such as cough, dyspnea, fever, body aches, and headache, necessitating the identification of the causative agent.
Pontiac Fever - A milder, non-pneumonia illness that presents with influenza-like symptoms, including fever and body aches, which may also require confirmation of Legionella pneumophila infection.
Suspected Infection - In cases where there is a suspicion of Legionella pneumophila infection due to exposure to contaminated water sources, especially in individuals presenting with respiratory symptoms.

2. Procedure

The procedure for performing the test associated with CPT® Code 87278 involves several critical steps to ensure accurate detection of Legionella pneumophila. The following procedural steps are outlined:

Sample Collection - A sample is obtained from the patient, which may include lung tissue, pleural fluid, pericardial fluid, nasopharyngeal or bronchial washings, or sputum. The choice of sample depends on the clinical presentation and the suspected site of infection.
Preparation of the Sample - The collected sample is treated with a detecting reagent that contains antibodies specific to Legionella pneumophila. This reagent is crucial for the subsequent detection of the bacterium's antigens.
Counterstaining - A counterstain is applied to the sample to enhance visualization under the microscope. This step is essential for differentiating the specific binding of antibodies to the antigens from the background staining.
Microscopic Examination - The prepared sample is examined under an epifluorescence microscope. The presence of Legionella pneumophila is indicated by a distinct color change, which occurs when the antibodies in the detecting reagent bind to the antigens present in the bacterium.

3. Post-Procedure

After the completion of the test associated with CPT® Code 87278, the following post-procedure considerations should be noted. The results of the immunofluorescent test will be interpreted by a qualified laboratory professional, and the findings will be reported to the requesting physician. If Legionella pneumophila is detected, appropriate clinical management and treatment options will be discussed based on the patient's condition. It is important to consider that while this test provides rapid results, it may be less sensitive than culture methods or RT-PCR, and further testing may be warranted if clinical suspicion remains high despite negative results. Additionally, proper documentation of the test results and any follow-up actions taken is essential for maintaining compliance and ensuring continuity of care.

Short Descr	LEGION PNEUMOPHILIA AG IF
Medium Descr	IAADI LEGIONELLA PNEUMOPHILA
Long Descr	Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila
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	1
CCS Clinical Classification	206 - Microscopic examination (bacterial smear, culture, toxicology)

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
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.
GW	Service not related to the hospice patient's terminal condition