Clinical Context
A 6-week-old neonate presents to the hospital neonatal intensive care unit with petechial rash, hepatosplenomegaly, and transaminitis. The neonate was born to a mother with suspected primary Cytomegalovirus infection during pregnancy. A clinician orders laboratory testing on a urine and nasopharyngeal specimen to detect active CMV infection using a direct fluorescent antibody technique. A laboratory technologist performs 87271 (direct fluorescent antibody, CMV antigen) on the specimen. The workflow includes specimen receipt and accessioning, preparation of slides and reagents, staining with CMV-specific fluorescent-labeled antibodies, microscopic examination by the lab analyst, documentation of positive or negative antigen detection, and reporting of results to the ordering pediatric infectious disease clinician and the hospital electronic medical record system.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | When billing only the physician or laboratorian professional interpretation portion of a split service |
59 | Distinct procedural service | When another diagnostic test is performed on the same day and the CMV DFA is a distinct service
62 | Two surgeons | If two qualified laboratorians with distinct roles are required for a complex testing process (rare)
78 | Unplanned return to the operating/procedure room | Not typically applicable; included when an unplanned repeat intra-procedure test is required immediately
80 | Assistant surgeon | Not typically applicable for lab-only services but used when an assisting professional provides a required component
90 | Reference (outside) laboratory | When the specimen is sent to an outside reference laboratory for performance of 87271
TC | Technical component | When billing only the laboratory technical component (equipment, reagents, technician work)
QX | Modifier indicating clinician performed the non-physician practitioner's services were furnished by a CRNA (specific to anesthesia) | Rarely applicable; included only if regulatory reporting or payer requires
QY | Attending practitioner of record in teaching setting | Use when a resident performs portions under supervision and payer recognition of teaching physician rules applies
59 | Distinct procedural service | Use when test is separate and independent from other services billed on the same day
| Taxonomy Code | Specialty | Notes |
|---|
0000A | Clinical Laboratory Scientist / Medical Technologist | Performs specimen processing and DFA staining and microscopy |
0000B | Pathology / Clinical Pathology | Laboratory medical director oversight and result validation
0000C | Infectious Disease | Ordering and interpreting physician for pediatric or neonatal CMV diagnosis
0000D | Pediatrics / Neonatology | Ordering clinician and clinical team managing the neonate
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
P35.1 | Congenital cytomegalovirus infection | Primary diagnosis indicating congenital CMV; direct indication for 87271 antigen testing |
B25.9 | Cytomegaloviral disease, unspecified | Diagnosis for active CMV disease where antigen detection can support clinical assessment
R53.1 | Weakness | Non-specific symptom that may prompt broader infectious workup including CMV testing in infants
R17 | Unspecified jaundice | Neonatal jaundice can be a manifestation of congenital CMV and prompt antigen testing
P59.9 | Neonatal jaundice, unspecified | Used when evaluating neonatal hyperbilirubinemia potentially related to CMV infection
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
87270 | Smear, primary staining for bacteria by direct fluorescent antibody technique (e.g., Legionella, Chlamydia) | Similar direct fluorescent antibody methodology; sometimes performed in the same laboratory workflow when multiplex DFA panels are used |
87440 | Infectious agent antigen detection by immunoassay technique; adenovirus | Alternate antigen detection methods for viral pathogens; used when antigen immunoassays are preferred or available
87499 | Unlisted miscellaneous pathology procedure | Used rarely when a codable antigen detection test is not available or when unique testing methodology requires unlisted coding
87070 | Culture, bacterial, with isolation and presumptive identification | May be ordered concurrently for evaluation of concurrent bacterial infection in neonates