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The CPT® Code 87476 refers to a laboratory test designed for the detection of the infectious agent Borrelia burgdorferi through nucleic acid analysis, specifically utilizing either DNA or RNA. Borrelia burgdorferi is a type of bacterium that is primarily transmitted to humans via the bite of an infected black-legged tick, and it is widely recognized as the causative agent of Lyme disease. This particular test is particularly valuable in clinical scenarios where Lyme disease is highly suspected, yet serological tests yield negative results. The nucleic acid detection method is employed to identify the presence of the bacterium's unique genetic material, which can be found in various biological samples such as blood, tissue, cerebrospinal fluid (CSF), or synovial fluid. The process involves a direct probe test, which identifies a specific nucleic acid sequence known as the target sequence of the B. burgdorferi organism. This is achieved by using a probe that is labeled with either fluorescent or chemiluminescent markers. The biological sample is treated to release nucleic acids from the target organism, if it is present. The labeled probe then selectively binds to the target sequence, forming a stable hybrid. Notably, ribosomal RNA is often the focus of these tests due to its abundance in microorganisms, as it exists in thousands of copies compared to the limited 1-2 copies found in genomic DNA. In the amplified probe technique associated with CPT® Code 87476, the sensitivity of the assay is significantly enhanced by first exponentially amplifying the target sequence of B. burgdorferi DNA or RNA into millions of copies. The most prevalent amplification methods utilized in this context include polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR). Following amplification, the replicated sequences are identified using labeled DNA probes, thereby increasing the likelihood of detecting the presence of Borrelia burgdorferi in the sample.
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The CPT® Code 87476 is indicated for use in specific clinical scenarios where the detection of Borrelia burgdorferi is necessary. The following conditions warrant the performance of this test:
The procedure for CPT® Code 87476 involves several critical steps to ensure accurate detection of Borrelia burgdorferi. The following outlines the procedural steps:
Post-procedure care for patients undergoing testing with CPT® Code 87476 typically involves monitoring for any immediate reactions to the sample collection, especially if blood or other invasive samples were taken. Patients may be advised to follow up with their healthcare provider to discuss the results of the test, which can take several days to process. It is essential for healthcare providers to interpret the results in conjunction with clinical findings and other diagnostic tests to confirm or rule out Lyme disease. Additionally, any necessary treatment plans should be discussed based on the test outcomes and the patient's overall clinical picture.
| Short Descr | LYME DIS DNA AMP PROBE | Medium Descr | IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique | 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) |
| 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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 | Q4 | Service for ordering/referring physician qualifies as a service exemption | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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