How To Use CPT Code 83516

CPT 83516 is a code for immunoassay testing of noninfectious analytes using a multiple step method, providing qualitative or semiquantitative results. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 83516.

1. What is CPT 83516?

CPT 83516 is a code used to describe a laboratory test that involves the use of immunoassay techniques to detect and measure noninfectious analytes in a patient’s specimen, such as blood or urine. The test is performed using a multiple step method, and the results are presented in either a qualitative (positive or negative) or semiquantitative (numeric) format. This code is used by medical professionals to accurately document and bill for this specific laboratory service.

2. 83516 CPT code description

The official description of CPT code 83516 is: “Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method.”

3. Procedure

The 83516 procedure involves the following steps:

1. Collection of the appropriate specimen, typically blood or urine, from the patient.
2. Specimen pretreatment, if necessary, to prepare it for testing.
3. Incubation of the specimen with specific reagents to facilitate the antigen-antibody reaction.
4. Centrifugation to separate the reacted components from the unreacted ones.
5. Use of automated instrumentation to detect and measure the target analyte in the specimen.
6. Interpretation of the results, which may be qualitative (positive or negative) or semiquantitative (numeric).

4. Qualifying circumstances

Patients who are eligible to receive CPT code 83516 services are those who require testing for noninfectious analytes using immunoassay methods. This may include individuals with suspected or confirmed medical conditions that can be diagnosed or monitored through the detection and measurement of specific noninfectious analytes in their blood or urine. Examples of such conditions may include hormonal imbalances, autoimmune disorders, or certain types of cancer.

5. When to use CPT code 83516

It is appropriate to bill the 83516 CPT code when a healthcare provider orders an immunoassay test for a noninfectious analyte using a multiple step method, and the test is performed by a qualified laboratory professional. The code should be used to accurately document and bill for the specific laboratory service provided to the patient.

6. Documentation requirements

To support a claim for CPT 83516, the following information should be documented:

• The patient’s demographic information, including name, date of birth, and insurance information.
• The ordering healthcare provider’s name and contact information.
• The specific noninfectious analyte being tested and the reason for the test (e.g., diagnosis, monitoring, or screening).
• A detailed description of the multiple step immunoassay procedure performed, including the specimen type, reagents used, and instrumentation involved.
• The test results, presented in either a qualitative or semiquantitative format.
• Any relevant interpretations or recommendations based on the test results.

7. Billing guidelines

When billing for CPT code 83516, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips for billing this code include:

• Ensure that the documentation supports the medical necessity of the test and the use of the multiple step method.
• Verify that the test was ordered by a qualified healthcare provider and performed by a qualified laboratory professional.
• Include all required documentation, as outlined in the previous section, to support the claim.
• Review any payer-specific guidelines or requirements related to billing for CPT 83516, as these may vary between insurance companies.

8. Historical information

CPT 83516 was added to the Current Procedural Terminology system on January 1, 1995. The code was updated on January 1, 2010, with a change in the descriptor to its current form: “Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method.”

9. Similar codes to CPT 83516

There are several other CPT codes related to immunoassay testing that differentiate from CPT 83516 in various ways. Some examples include:

• CPT 83518: This code is used for immunoassay testing of infectious agent antibodies or antigens, rather than noninfectious analytes.
• CPT 83519: This code is for immunoassay testing of noninfectious analytes using a single step method, as opposed to the multiple step method described by CPT 83516.
• CPT 83520: This code is for quantitative immunoassay testing, which provides a more specific numeric result than the qualitative or semiquantitative results of CPT 83516.
• CPT 83525: This code is for immunoassay testing of insulin, a specific noninfectious analyte, using a multiple step method.
• CPT 83540: This code is for immunoassay testing of iron-binding capacity, another specific noninfectious analyte, using a multiple step method.

10. Examples

Here are 10 detailed examples of CPT code 83516 procedures:

1. Testing for thyroid-stimulating hormone (TSH) in a patient with suspected hypothyroidism.
2. Measuring cortisol levels in a patient with suspected Cushing’s syndrome.
3. Assessing levels of prostate-specific antigen (PSA) in a patient undergoing prostate cancer screening.
4. Testing for antinuclear antibodies (ANA) in a patient with suspected lupus.
5. Measuring levels of follicle-stimulating hormone (FSH) in a patient undergoing fertility evaluation.
6. Assessing levels of carcinoembryonic antigen (CEA) in a patient with colorectal cancer to monitor treatment response.
7. Testing for anti-thyroid peroxidase (TPO) antibodies in a patient with suspected Hashimoto’s thyroiditis.
8. Measuring levels of human chorionic gonadotropin (hCG) in a patient undergoing pregnancy testing.
9. Assessing levels of alpha-fetoprotein (AFP) in a patient with liver cancer to monitor treatment response.
10. Testing for anti-double-stranded DNA (dsDNA) antibodies in a patient with suspected lupus nephritis.