CPT 87635 Code
American Medical Association declared 80000 series codes representing laboratory and pathology procedures in CPT Manual book. CPT code 87635 is also from this chapter used to report laboratory testing services for diagnosing Coronavirus in category I pathology and laboratory code set.
CPT 87635 is a code with long, medium, and short descriptors.
Long Code Descriptor:
Infectious agent detection by nucleic acid (DNA or RNA) represents severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease[COVID-19]), amplified probe technique
Medium Code Descriptor:
IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ
Short Code Descriptor:
SARS-COV-2 COVID-19 AMPIPROBE Test
Description of the procedure for the CPT 87635 code:
Firstly the specimens are placed into specimen transport containers, then oligonucleotide primers and probes are used to detect severe acute respiratory syndrome coronavirus 2. In the end, ribonucleic acid (RNA) is isolated from the specimen, purified, and sent to the patient’s physician or the laboratories for the results.
The CPT code 87635 should be reported by payers other than Medicare for testing for COVID-19.
Billing covid-19 varies according to the following scenarios:
Case 1: In this case, the laboratory receives the specimen and performs the test.
It is to be noted that we cannot bill for laboratory tests if the laboratory is not performing the test. Billing is done as follows:
- Use the CPT code 87635.
- On the physician’s order, use ICD DX codes as:
- For suspected exposure to COVID-19: ICD dx Z03.818
- For exposure to a confirmed case of COVID-19: ICD dx Z20.828
- For contact with and (suspected) exposure to covid-19: ICD dx Z20.822
Case 2: It is for the care providers who collect the specimen for the COVID-19 test and send them to the approved locations. This billing is covered under the office visit. Billing is done as follows:
- Use appropriate office visit evaluation and management code according to the level of evaluation and management (Low, moderate, or high E&M).
- For suspected exposure to COVID-19, use ICD dx Z03.818.
- For exposure to a confirmed case of COVID-19, use ICD dx Z20.828.
- For contact with and (suspected) exposure to covid-19, use ICD dx Z20.822.
Additional note 1: Use code 99001 for billing COVID-19 if the specimen is collected anywhere other than the physician’s office and 99000 if collected in the office and transported to the laboratory.
Additional note 2: Reporting the code for COVID-19 depends on the payer to which the claim is being submitted. If the payer wants the claim to be coded in CPT code, then code 87635 should be used, and if the payer requires an HCPCS level II code, then the codes like U0001, U0002, U0003, or U0004, etc., should be used instead. CPT and HCPCS codes shouldn’t be used in the same claim.
CPT 87635 code – Diagnosis coding for covid-19:
For the diagnosis of covid-19, a new code U07.1 was added in chapter 22 of the ICD-10 CM guidelines. This chapter consists of codes for particular purposes (U00-U85].
- Use code U07.1 only if the test results are positive and covid-19 is confirmed.
- 1 is sequenced first, and the further associated manifestations follow.
The associated manifestations (along with their codes) can be as follows:
R05- for cough
R06.02- for shortness of breath
R50.9- for fever, unspecified
J12.89- for other viral pneumonia
J20.8- for acute bronchitis due to other specified organisms
J22- for unspecified acute lower respiratory infection
J40- for bronchitis, nor specified as acute or chronic
J44.1- for COPD exacerbation ( characterized by airway abnormalities and irreversible airflow limitation. Complaints include dyspnea, chest pain, increased sputum production, and purulence).
J80- for acute respiratory distress syndrome
J96.01- for acute respiratory failure with hypoxia
J98.8- for other specified respiratory disorders
If COVID-19 is not confirmed or the laboratory test results are negative, the following ENCOUNTER codes should use:
Z11.59- Encounter for screening for other specified viral diseases, unknown or negative results.
Z03.818- Encounter for observing the suspected exposure to other biological agents or possible exposure to COVID-19 infection
Z20.2- Contact with and (suspected) exposure to other viral infectious diseases or contact with covid-19 (suspected exposure)
Other codes for covid-19 laboratory testing:
86328 and 86769 are used to identify the presence of antibodies to covid-19 virus.
The description of these codes is as follows:
86328- Immunoassay for infectious agents antibodies, qualitative or semi-quantitative, single-step method (e.g., reagent strip) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Coronavirus disease [COVID 19]).
Other code Covid-19 CPT code:
86769- Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Addition of QW modifier to CPT 87635 Code:
Medicare permits using code 87635 with modifier QW for the claim the facility submits with a valid CLIA (Clinical Laboratory Improvement Amendments) certificate. This certificate allows the laboratories to legally examine a person through waived tests to assess, diagnose the condition and present the plan of care.
Modifiers used with CPT 87635 Code:
The most commonly used modifier with 87635 is QW (CLIA waived test).
Other modifiers include 59 (Distinct procedure), 76, and 77.
Claim Coding, Submissions, and Reimbursement; United Healthcare; 2022.
New CPT code announced to report novel coronavirus test; American Medical Association; 2020.
Jitendra M. Sc CPC; CPT Code 87635 : COVID-19 coding guidelines ; Medical Coding Guide; 2022.