CPT® Code 87906

Official Description

Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion)

Common Language Description

The CPT® Code 87906 refers to the process of conducting an infectious agent genotype analysis specifically for HIV-1, focusing on regions other than those typically associated with reverse transcriptase and protease inhibitors. This analysis is crucial for identifying mutations within the HIV-1 genome that may lead to resistance against certain antiretroviral therapies, particularly those targeting the integrase enzyme, which is essential for the viral replication process. The integrase gene mutations can indicate resistance to integrase inhibitors such as raltegravir and elvitegravir, which are vital components of treatment regimens for HIV infection. HIV, or human immunodeficiency virus, is a retrovirus that primarily attacks the immune system by targeting CD4 T cells, which are critical for immune response. The progression of untreated HIV can lead to acquired immunodeficiency syndrome (AIDS), a severe condition characterized by a significantly weakened immune system. Given the high replication rate of HIV and the propensity for mutations during replication, initial treatment often involves highly active antiretroviral therapy (HAART), which combines multiple drugs with different mechanisms to effectively reduce viral load and minimize the risk of resistance. When initial therapies fail, performing a genotype analysis becomes essential to tailor subsequent treatment strategies. This complex test utilizes a blood sample to assess the presence of specific nucleic acid sequences associated with drug resistance, employing techniques such as polymerase chain reaction (PCR) for amplification, purification, and comparative analysis against known resistance profiles. The insights gained from this analysis are instrumental in formulating a more effective drug regimen aimed at controlling the HIV infection and improving patient outcomes.

1. Indications

The CPT® Code 87906 is indicated for use in the following scenarios:

HIV Treatment Failure This test is performed when initial antiretroviral therapy fails to achieve the desired viral suppression, indicating potential drug resistance.
Assessment of Drug Resistance It is utilized to identify specific mutations in the HIV-1 genome that confer resistance to integrase inhibitors, guiding the selection of alternative treatment options.
Monitoring of HIV-1 Variants The analysis helps in monitoring changes in the viral genome over time, particularly in patients with a history of treatment failure or those experiencing virologic rebound.

2. Procedure

The procedure for conducting the genotype analysis for HIV-1 as per CPT® Code 87906 involves several critical steps:

Step 1: Sample Collection A blood sample is collected from the patient, which serves as the source of nucleic acids for the analysis. This sample is essential for the subsequent steps of the testing process.
Step 2: Nucleic Acid Amplification The collected sample undergoes amplification of specific nucleic acid sequences associated with the HIV-1 genome. This is typically achieved using polymerase chain reaction (PCR), a technique that exponentially increases the quantity of targeted DNA or RNA sequences, making them detectable for further analysis.
Step 3: Purification and Molecular Analysis After amplification, the resulting product is purified to remove any contaminants that may interfere with the analysis. Following purification, further molecular analysis is conducted to evaluate the amplified sequences for known mutations that are associated with drug resistance.
Step 4: Comparison to Known Resistance Profiles The final step involves comparing the identified sequences against established databases of known mutations that confer resistance to specific antiretroviral drugs. This comparison provides critical information that informs the development of a tailored drug regimen aimed at effectively managing the patient's HIV infection.

3. Post-Procedure

Post-procedure care following the genotype analysis for HIV-1 typically involves the interpretation of results by a qualified healthcare professional. Patients may be advised on the implications of the findings, particularly regarding their treatment options. It is essential to discuss the results in the context of the patient's overall treatment plan, including potential adjustments to their antiretroviral therapy based on the identified mutations. Continuous monitoring and follow-up testing may be recommended to assess the effectiveness of the new treatment regimen and to ensure ongoing management of the HIV infection.

Short Descr	NFCT AGT GNTYP ALYS HIV1
Medium Descr	NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 OTHER REGION
Long Descr	Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion)
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	2
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.
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.
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.
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure