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The CPT® Code 87561 refers to a laboratory test designed for the detection of the infectious agent Mycobacteria avium-intracellulare (MAI) through the use of nucleic acid amplification techniques. MAI consists of two species of gram-positive, acid-fast, atypical bacteria that are collectively known as the Mycobacteria avium complex (MAC). These bacteria are commonly found in environmental sources such as water and soil, and they can also be carried by birds and farm animals. Infections caused by MAI primarily affect the lungs, leading to a range of symptoms that may include a productive cough with significant sputum production, fever, weight loss, fatigue, and night sweats. The test utilizes an amplified probe technique to identify the unique nucleic acid sequences associated with the MAI organism. This is achieved by analyzing samples from various bodily fluids, including blood, tissue, cerebrospinal fluid (CSF), or synovial fluid. The process begins with the extraction of nucleic acids from the target organism, if present in the sample. A labeled probe, which may be fluorescent or chemiluminescent, is then introduced to the sample. This probe specifically binds to the target sequence of the MAI organism, forming a stable hybrid. In the amplified probe technique, the sensitivity of the assay is significantly enhanced by exponentially amplifying the target sequence of MAI DNA or RNA, resulting in millions of copies. The most prevalent amplification methods employed are polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR). Following amplification, the replicated sequences are identified using labeled DNA probes. Additionally, nucleic acid detection with quantification can be performed to assess the quantity of microorganisms present in the sample, often utilizing quantitative or real-time PCR to provide detailed reports on the absolute or relative amounts of the nucleic acid sequences detected.
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The procedure associated with CPT® Code 87561 is indicated for the detection of Mycobacteria avium-intracellulare (MAI) in patients who may be exhibiting symptoms consistent with an MAI infection. The following conditions and symptoms warrant the performance of this test:
The procedure for CPT® Code 87561 involves several critical steps to ensure accurate detection of Mycobacteria avium-intracellulare (MAI). The following outlines the procedural steps:
After the completion of the procedure associated with CPT® Code 87561, the laboratory will analyze the results to determine the presence of Mycobacteria avium-intracellulare. The findings will be documented in a report, which may include quantitative data if nucleic acid detection with quantification was performed. Clinicians will use this information to guide further diagnostic and therapeutic decisions. It is important for healthcare providers to consider the clinical context and symptoms when interpreting the results, as the presence of MAI may necessitate additional follow-up or treatment interventions.
| Short Descr | M.AVIUM-INTRA DNA AMP PROB | Medium Descr | IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, 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. | 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 | 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. | 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. | 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 | 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 |
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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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