87389 CPT Code Guide for HIV Screening Awareness Initiatives

On March 20, the National Native HIV/AIDS Awareness Day, it is necessary to discuss the necessity of easy access to HIV testing. In the case of medical billing professionals, it is necessary to support such initiatives with the help of proper coding. The code of 87389 CPT is the code of modern HIV screening, which is a combination of antigen and antibody tests in one test.

Billing Care Solutions deals with lab coding. This guide offers the necessary information regarding this code to be accurately reimbursed.

Understanding the 87389 CPT Code for HIV Screening

CPT code 87389 CPT represents a fourth generation diagnosis test of HIV. In comparison to the older system where different codes are used, this code provides detailed results of one assay.

Key points about this code include:

• The formal CPT coding of this code is HIV 1 antigen with HIV 1 and HIV 2 antibodies, single result.
• The test identifies two different signs of HIV infection at the same time.
• The p24 antigen is also early to manifest and it develops at a time when there are no antibodies.
• This code decreases the window period by measuring the antigens and antibodies both.
• This code is a complete testing methodology.

In the case of medical coders who work with HIV screening awareness programs, this code is critical in the submission of a claim.

Clinical Significance in HIV Screening

Clinical benefits of this code render it the solution of choice in terms of HIV screening programs.

Noteworthy clinical features of this code are:

• The major advantage of this code is that it can identify acute HIV infection.
• The old antibody tests may not detect infections within the initial couple of weeks.
• The reason is that this code is able to detect p24 antigen thus detecting infections earlier.
• Early detection of this code allows rapid connection to care.
• This code assists in decreasing the uninformed spreading.
• CDC suggests regular checking of HIV with the help of such tests as 87389.
• The USPSTF recommends this code in screening of persons aged between 15 and 65 years.

In case of physician-ordered HIV screening, one usually reports to this code.

Specimen Requirements for 87389

Adequate collection of the specimen affects this code testing accuracy and its billing.

Requirements of 87389 specimens are:

• Serums in serum separator tubes are acceptable specimens.
• Serum collection Red top tubes are acceptable with this code.
• The lavender top EDTA plasma is applicable in this code testing.
• Each of the alternatives should be tested to quality standards.

Test methodology for 87389 includes:

• This code test technique is the immunoassay technology.
• Multiplex flow immunoassay is a commonly used method of this code.
• The method enables the multiple detection of analytes.
• There is only one result of this code yet both antigens and antibodies are measured.

Age restrictions for 87389 include:

• The test has been validated in people whose ages are two years or above.
• In the case of neonatal testing, alternative methodologies are required.
• Check patient age on claims of this code.

Modifier guidance for 87389 includes:

• When used together with unrelated procedures, modifier 59 can be applied to this code.
• Procedures that are not related have to be on different grounds within a day.
• Do not use modifier 59 to avoid the bundling of related HIV tests with this code.

Reflex Testing for 87389

The reflex protocol linked to 87389 codes complicates the coding process but ensures proper confirmatory tests.

The reflex sequence of this code is:

• In cases where this code has yielded reactive results, confirmatory testing is done in the laboratory.
• This reflex testing has a rational order to establish positive results.
• Following results of reactive this code, the cascade distinguishes between HIV 1 and HIV 2.

After this code confirmatory testing includes:

• In the case of reactive 87389 results, the laboratory carries out antibody differentiation of the HIV 1 with the help of 86701.
• HIV 2 antibody differentiation is done in the laboratory by the use of 86702.
• These codes determine a certain type of HIV occurring after this code screening.
• In case of indeterminate results of differentiation, the laboratory goes on to test HIV 1 RNA by use of 87535.

Billing considerations for reflex testing include:

• Every action in the reflex pathway produces different billable codes.
• The reflex codes have medical necessity based on these code results.
• Reactive this code test results are necessary to confirm necessity in confirmatory testing.

Payer Guidelines for 87389

The 87389 payer policies vary with the majority of the insurers acknowledging the relevance of HIV screening and covering it.

Medicare coverage for 87389 includes:

• Medicare addresses screening of at risk patients.
• The cost of the test is billed as Medicare covers this code to any patient requesting taking the test.
• Medicare provides voluntary screening of pregnant women with the help of this code.
• The reason for testing should be reflected in this code diagnosis coding.

The Medicaid coverage of 87389 comprises:

• Most Medicaid programs in the state comply with the guidelines of this code.
• The state may have specific diagnosis requirements of this code.
• In certain states, particular Z codes of screening status of this code are mandatory.

In commercial insurance, which covers this code, it covers:

• The coverage of this code by a physician is usually covered by commercial insurers.
• The medical necessity of this code is provided by clinical opinion and risk factors.
• Certain insurers might demand pre-authorization of this code.

The coverage considerations of this code are very important and consist of:

• Check covering on opt out screening programs.
• Knowledge on payer preferences avoids this code rejections.
• Testing reason should be translated into diagnosis coding of this code.

Compliance for 87389 Billing

Adequate billing should be done with proper documentation to demonstrate the necessity of the test, which should include the ordering of the test, medical indications and test results. Claims should be made according to the requirements of the payer and should not be unbundled or charged on tests that have not been done, which is regarded as a fraud. 

The frequent audits aids in the detection of errors, compliance, and the proper billing activities. A strong compliance initiative ought to take into account 87389 billing, particularly to minimize risk, facilitate regulatory demands, and make sure that HIV screening services are correctly and effectively billed.

Conclusion:

CPT 87389 Use only without the other codes of HIV testing on the same claim. Know how to test the reflex and at what time confirmatory codes are applicable. Payers, diagnosis, and age of patient, always check to guarantee the accuracy in clinical and billing. The patterns of denials should be monitored to enhance the acceptance of claims.

Billing Care Solutions provides professional advice and assistance in proper, compliant of this code  billing to assist practices in managing initiatives on HIV screening as well as ensuring maximum reimbursement and adherence to rules.

Frequently Asked Questions