Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid
(DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe
technique)

The purpose of this article is to alert providers that National Government
Services considers CPT code 87641 to be a test used for screening purposes for
which payment will not be allowed.

Screening tests are statutorily non-covered based on Title VIII of the Social
Security Act, Section 1862(a)(1)(A) which excludes expenses incurred for items
or services which are not reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a malformed
body member.

**Background:**

Methicillin-resistant S. aureus (MRSA) was first described in 1961 and now
constitutes more than 50% of S. aureus isolates that cause infections in the
hospital setting.  
  
The worldwide emergence of MRSA is mainly the result of the extensive spread
of a limited number of strains in hospitals, which are high risk settings for
MRSA infection. _Staphyloccocus aureus_ is an opportunistic pathogen that
mainly infects patients who have had surgery or who have invasive devices
(such as intravascular catheters). The epidemiology of MRSA has changed
recently-- infections are no longer confined to the hospital setting, but also
appear in healthy people in the community with no established risk factors for
acquiring MRSA. These community associated MRSA strains differ from hospital
associated strains. Most carriers of _S aureus_ , both hospital inpatients and
others, are healthy asymptomatic people without evident infection. In
hospitals where MRSA is endemic, patients risk being colonized by spread from
other patients or healthcare workers. Colonization with _S aureus_ in hospital
is a risk factor for subsequent infection. (Kluytmans J, 2009).  
  
CPT code 87641 was established to report methicillin resistant Staphylococcus
aureus (MRSA) by amplified probe technique and it is used to bill for "assays
that detect methicillin resistance and identify Staphylococcus aureus using a
single nucleic acid sequence." ( _CPT Changes 2007 - An Insider's View_)  
  
The availability of nucleic acid probes has permitted the rapid direct
identification of microorganisms' DNA or RNA. Amplification techniques,
including, but not limited to the polymerase chain reaction (PCR), results in
the doubling of copies of specified target DNA with each round of
amplification, eventually resulting in millionfold levels of amplification.
The product of the amplification (i.e., DNA) is then detected using a variety
of techniques. ((C)Blue Cross & Blue Shield of Mississippi. Identification of
Microorganisms Using Nucleic Acid Probes)Although some hospitals are screening
patients prior to inpatient or outpatient hospitalization to identify carriers
of methicillin resistant Staphylococcus aureus as an infection control
measure, additional research will be required to demonstrate whether the use
of universal rapid MRSA admission screening will reduce nosocomial MRSA
infection in hospitals compared to the use of alternative control measures
against MRSA.  
  
Screening tests are statutorily non-covered based on Title VIII of the Social
Security Act, Section 1862(a)(1)(A) which excludes expenses incurred for items
or services which are not reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a malformed
body member. This purpose of this article is to alert providers that National
Government Services considers CPT code 87641 to be a test used for screening
purposes for which payment will not be allowed.  
  
 **Specific Coding Guideline:**

Claims for CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or
RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)
services are not payable under Medicare Part B for screening purposes and will
be denied.

When billing CPT code 87641 for screening purposes (statutorily non-covered),
ICD-10-CM codes, including but not limited to those listed below, may be
reported. The -GY modifier should be reported, as applicable.

  
 **Coding Information:**  
  
Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.  
  
For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.  
  
A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.  
  
The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.