CPT® Code 87640

Official Description

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

Common Language Description

The CPT® Code 87640 refers to the detection of the infectious agent Staphylococcus aureus through nucleic acid testing, specifically utilizing an amplified probe technique. This method is particularly significant in the realm of infectious disease diagnostics as it allows for the identification of Staphylococcus aureus infections, including those that are methicillin-resistant (MRSA), by analyzing the DNA or RNA of the pathogen. The amplified probe technique is a sophisticated approach that enhances the sensitivity of detection, making it possible to identify even minimal quantities of the infectious agent, sometimes down to a single organism. This is achieved through a process known as nucleic acid hybridization, where the DNA or RNA of the infectious agent is released from the cell and extracted. The extraction process involves the use of specially designed probes, which are laboratory-prepared complementary strands of nucleic acid that bind to the target DNA. These probes are often labeled with chemical fluorescence to facilitate the identification of the hybridized complexes. The amplification aspect of this technique employs methods such as polymerase chain reaction (PCR), which enzymatically replicates specific sequences of the target DNA, thereby increasing the amount of detectable material. This is accomplished through the use of amplification primers, which are short strands of DNA that are complementary to the target DNA and help initiate the replication process. Overall, the use of CPT® Code 87640 represents a critical advancement in the rapid and accurate diagnosis of Staphylococcus aureus infections, providing healthcare professionals with a powerful tool for patient management.

1. Indications

The CPT® Code 87640 is indicated for the detection of Staphylococcus aureus infections, including both methicillin-sensitive and methicillin-resistant strains. This testing is particularly useful in clinical scenarios where rapid identification of the pathogen is crucial for effective treatment and management of the infection. The following conditions may warrant the use of this procedure:

Staphylococcus aureus Infection Identification of infections caused by Staphylococcus aureus, which can lead to various clinical manifestations, including skin infections, pneumonia, and bloodstream infections.
Methicillin-Resistant Staphylococcus aureus (MRSA) Detection of MRSA, a strain of Staphylococcus aureus that is resistant to methicillin and other antibiotics, necessitating alternative treatment strategies.
Diagnostic Confirmation Situations where traditional culture methods may be inconclusive or delayed, and rapid diagnosis is essential for patient care.

2. Procedure

The procedure associated with CPT® Code 87640 involves several critical steps to ensure accurate detection of Staphylococcus aureus through nucleic acid amplification. The following outlines the procedural steps:

Sample Collection A specimen is collected from the patient, which may include swabs from infected sites, blood samples, or other relevant biological materials. Proper collection techniques are essential to avoid contamination and ensure the integrity of the sample.
Nucleic Acid Extraction The collected sample undergoes a process to extract nucleic acids (DNA or RNA) from the infectious agents present. This step involves lysing the cells to release the nucleic acids and purifying them for further analysis.
Probe Hybridization Once the nucleic acids are extracted, they are subjected to hybridization with specific probes designed to bind to the target sequences of Staphylococcus aureus. These probes are complementary strands of nucleic acid that will form stable complexes with the target DNA or RNA.
Amplification The hybridized nucleic acids are then amplified using techniques such as polymerase chain reaction (PCR). This involves the use of amplification primers that bind to specific regions of the target DNA, allowing the polymerase enzyme to replicate these regions exponentially, thereby increasing the amount of detectable material.
Detection Following amplification, the presence of the target nucleic acids is detected, often through fluorescence or other labeling methods that indicate successful hybridization and amplification. This step confirms the presence of Staphylococcus aureus in the sample.

3. Post-Procedure

After the completion of the procedure associated with CPT® Code 87640, the results are analyzed and interpreted by qualified laboratory personnel. The findings are then reported to the healthcare provider, who will use the information to guide treatment decisions. It is important to note that while nucleic acid detection provides rapid results, clinical correlation with patient symptoms and other diagnostic findings is essential for accurate diagnosis and management. Additionally, any necessary follow-up testing or monitoring may be recommended based on the results obtained from this procedure.

Short Descr	STAPH A DNA AMP PROBE
Medium Descr	IADNA S AUREUS AMPLIFIED PROBE TQ
Long Descr	Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, 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.
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
T5	Right foot, great toe
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
T6	Right foot, second digit
GZ	Item or service expected to be denied as not reasonable and necessary
LT	Left side (used to identify procedures performed on the left side of the body)
T7	Right foot, third digit
TA	Left foot, great toe
T8	Right foot, fourth digit
T3	Left foot, fourth 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.
GA	Waiver of liability statement issued as required by payer policy, individual case
SA	Nurse practitioner rendering service in collaboration with a physician
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.
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.)
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.
F3	Left hand, fourth digit
F4	Left hand, fifth digit
F5	Right hand, thumb
F6	Right hand, second digit
FA	Left 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
KX	Requirements specified in the medical policy have been met
PD	Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
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
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)
QW	Clia waived test
RT	Right side (used to identify procedures performed on the right side of the body)
T1	Left foot, second digit
T2	Left foot, third digit
T4	Left foot, fifth digit
T9	Right foot, fifth digit
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter