CPT® Code 87481

Official Description

Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique

Common Language Description

The CPT® Code 87481 refers to the detection of infectious agents through nucleic acid techniques, specifically targeting Candida species using an amplified probe technique. This method involves the identification of Candida infections by analyzing either DNA or RNA present in a sample. Candida is a type of fungus that is typically found on the skin and in mucous membranes, such as those in the vagina, mouth, or rectum. Under normal circumstances, Candida exists harmlessly; however, it can become pathogenic, leading to a condition known as Candidiasis moniliasis, when there is a disruption in the body's chemical balance that allows the fungus to proliferate uncontrollably. Certain populations, including individuals on antibiotics, those with weakened immune systems, and infants, are particularly vulnerable to Candida infections. Candidiasis can manifest in various areas, including the mouth, skin, nails, and vagina, and in rarer cases, it may affect the esophagus or gastrointestinal tract. The nucleic acid tests for Candida are primarily conducted for vaginal infections, and some rapid tests can be performed in a physician's office using specialized test kits. The amplified probe technique utilized in CPT® Code 87481 is particularly beneficial when there is a suspicion of low levels of Candida in the specimen, as it enhances the detection capabilities beyond what direct probe methods can achieve.

1. Indications

The procedure associated with CPT® Code 87481 is indicated for the detection of Candida species in patients who may be experiencing symptoms of Candidiasis. The following conditions and situations warrant the use of this test:

Vaginal Infections Patients presenting with symptoms of vaginal candidiasis, such as itching, burning, and abnormal discharge, may require testing to confirm the presence of Candida species.
Immunocompromised Individuals Individuals with weakened immune systems, including those undergoing chemotherapy, organ transplant recipients, or individuals with HIV/AIDS, are at increased risk for Candida infections and may need testing.
Antibiotic Use Patients who have recently taken antibiotics may be at risk for overgrowth of Candida due to disruption of normal flora, making testing necessary to identify potential infections.
Infants Newborns, particularly those who are premature or have other health issues, may be susceptible to Candida infections and should be tested if symptoms arise.

2. Procedure

The procedure for CPT® Code 87481 involves several key steps to ensure accurate detection of Candida species through nucleic acid amplification techniques. The following procedural steps are outlined:

Sample Collection A sample is obtained, typically through a vaginal swab, which is crucial for the accurate detection of Candida nucleic acids. This sample is then prepared for testing.
Cell Lysis The collected sample undergoes a process where lysate is introduced to rupture all cells present in the sample. This step is essential to release the nucleic acids, which are the target for detection.
Amplification of Nucleic Acids An amplification technique, such as polymerase chain reaction (PCR), is employed to create multiple copies of the Candida nucleic acids. This step is particularly important when the initial sample may contain low levels of the target microorganism that would otherwise go undetected.
Detection of Amplified Nucleic Acids Following amplification, various techniques are utilized to detect the presence of the amplified Candida nucleic acids. This may involve the use of specific probes that bind to the target sequences.

3. Post-Procedure

After the completion of the procedure associated with CPT® Code 87481, the results are analyzed to determine the presence of Candida species in the sample. If Candida is detected, the results can provide valuable information regarding the severity of the infection and guide treatment decisions. It is important for healthcare providers to communicate the results to the patient and discuss potential treatment options, which may include antifungal medications. Additionally, follow-up testing may be necessary to monitor the effectiveness of treatment and ensure that the infection is resolved. Patients should be advised on any symptoms to watch for and when to seek further medical attention.

Short Descr	CANDIDA DNA AMP PROBE
Medium Descr	IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ
Long Descr	Infectious agent detection by nucleic acid (DNA or RNA); Candida species, 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	5
CCS Clinical Classification	206 - Microscopic examination (bacterial smear, culture, toxicology)

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.
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.
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.
GW	Service not related to the hospice patient's terminal condition
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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.
GA	Waiver of liability statement issued as required by payer policy, individual case
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
LT	Left side (used to identify procedures performed on the left side of the body)
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
RT	Right side (used to identify procedures performed on the right side of the body)
T5	Right foot, great toe
T6	Right foot, second digit
TA	Left foot, great toe
T2	Left foot, third digit
T4	Left foot, fifth digit
GZ	Item or service expected to be denied as not reasonable and necessary
T1	Left foot, second digit
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.
53	Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
77	Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 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.)
95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
AQ	Physician providing a service in an unlisted health professional shortage area (hpsa)
F3	Left hand, fourth digit
F4	Left hand, fifth digit
F5	Right hand, thumb
GF	Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital
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
HW	Funded by state mental health agency
KX	Requirements specified in the medical policy have been met
QW	Clia waived test
SA	Nurse practitioner rendering service in collaboration with a physician
T3	Left foot, fourth digit
T7	Right foot, third digit
T8	Right foot, fourth digit
T9	Right foot, fifth digit
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
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter
XP	Separate practitioner, a service that is distinct because it was performed by a different practitioner