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The CPT® Code 87500 refers to the detection of infectious agents through nucleic acid testing, specifically focusing on vancomycin resistance in bacteria, such as enterococcus species van A and van B. This procedure employs an amplified probe technique, which is a sophisticated method used to identify the presence of specific genetic material associated with antibiotic resistance. Vancomycin is a potent antibiotic commonly utilized to treat infections caused by gram-positive bacteria. However, the emergence of vancomycin-resistant enterococci (VRE) poses significant challenges in clinical settings, as these bacteria are increasingly resistant to treatment. The amplified probe technique involves obtaining a specimen from the patient, isolating the bacteria, and treating the cells to expose single-stranded nucleic acid molecules. These target nucleic acids then hybridize with a complementary probe nucleic acid sequence, forming a stable double-stranded complex. The subsequent enzymatic cleavage of this complex releases fragments of the nucleic acid probe, indicating the presence of vancomycin resistance. This method not only confirms the resistance but also allows for the identification of the specific genotype, either A or B, providing critical information for effective patient management and treatment strategies.
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The procedure associated with CPT® Code 87500 is indicated for the detection of vancomycin-resistant enterococci (VRE), particularly the van A and van B genotypes. This testing is crucial in patients who are suspected of having infections caused by these resistant strains, especially in cases where traditional antibiotic treatments may fail. The following conditions may warrant the use of this procedure:
The procedure for CPT® Code 87500 involves several critical steps to accurately detect vancomycin-resistant enterococci using the amplified probe technique. The following steps outline the process:
After the completion of the procedure associated with CPT® Code 87500, the results are analyzed to confirm the presence of vancomycin-resistant enterococci. If the test is positive, appropriate measures should be taken to manage the infection, which may include the use of alternative antibiotics that are effective against resistant strains. Additionally, infection control protocols should be implemented to prevent the spread of VRE within healthcare settings. Patients may require follow-up testing to monitor the effectiveness of treatment and to ensure that the infection is resolved. It is also essential to document the results and any subsequent actions taken in the patient's medical record for compliance and continuity of care.
| Short Descr | VANOMYCIN DNA AMP PROBE | Medium Descr | INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), 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) |
| 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. | 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 | T8 | Right foot, fourth digit | RT | Right side (used to identify procedures performed on the right side of the body) | T3 | Left foot, fourth digit | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | T5 | Right foot, great toe | T6 | Right foot, second digit | GZ | Item or service expected to be denied as not reasonable and necessary | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | 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 | SA | Nurse practitioner rendering service in collaboration with a physician | T2 | Left foot, third digit | T9 | Right foot, fifth digit | 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. | 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.) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | KX | Requirements specified in the medical policy have been met | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | ST | Related to trauma or injury | T1 | Left foot, second digit | T4 | Left foot, fifth digit | T7 | Right foot, third digit | TA | Left foot, great toe | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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Notes
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| 2011-01-01 | Changed | Short description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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