2025 CPT code 87520
Effective Date: N/A Pathology and Laboratory Procedures > Microbiology Procedures Feed
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique
Modifiers 59 and 91 are applicable to this code under specific circumstances.
Medical necessity for this test must be established. This means the test is necessary for the diagnosis, treatment, or management of a medical condition. Documentation supporting the medical necessity should be included in the patient's medical record. Examples of medical necessity for this test include: symptoms suggestive of hepatitis C, known risk factors for the disease, or monitoring treatment response. Simply ordering the test without a clear medical reason may lead to claim denial.
The laboratory analyst performs all technical steps required to perform the test. This includes specimen preparation, mixing the specimen with the nucleic acid probe, and visualizing the hybridization product. They are responsible for interpreting the results and reporting them accurately. It's important to note that while the analyst performs the technical aspects of the test, a physician orders the test and uses the results to guide patient care.
In simple words: This test checks for the presence of the hepatitis C virus in your blood or other sample by directly looking for the virus's genetic material (DNA or RNA). It uses a special "probe" that attaches to the virus's genes if they are present, and this attachment can then be seen in the lab. This test is different from antibody tests, which look for your body's response to the virus, not the virus itself.
This code represents a laboratory test for detecting the hepatitis C virus using a direct nucleic acid probe technique. This method uses a specifically designed DNA or RNA probe that binds to the complementary sequence in the patient's specimen, if present. The probe is labeled, allowing visualization of the hybridization product, thus indicating the presence of the virus. This is a direct detection method, meaning it identifies the presence of the viral genetic material itself, not antibodies produced in response to the infection.
Example 1: A patient presents with symptoms suggestive of hepatitis C, such as fatigue, jaundice, and abdominal pain. A physician orders this test to confirm the diagnosis by detecting the presence of the hepatitis C virus., A patient with a known history of intravenous drug use is being screened for hepatitis C. The direct probe technique is used to determine active infection, as it detects the virus itself rather than antibodies, which can persist even after the infection is cleared., A patient previously diagnosed with hepatitis C has undergone treatment. This test is used to monitor the effectiveness of the treatment by checking for the continued presence of the virus.
Documentation should include the reason for the test (e.g., signs and symptoms, risk factors, monitoring treatment response), the type of specimen collected, the date of collection, and the test result. It's also crucial to document the ordering physician and the laboratory that performed the test. Proper documentation ensures accurate billing and aids in tracking patient health over time.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Specialties:Infectious Disease, Gastroenterology, Hepatology, Internal Medicine, Family Medicine
- Place of Service:Office, Independent Clinic, Hospital (Inpatient and Outpatient), Federally Qualified Health Center, and independent Laboratory