How To Use CPT Code 86003

CPT 86003 refers to the allergen-specific IgE lab test using crude allergen extract, with quantitative 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 86003.

1. What is CPT 86003?

CPT 86003 is a code used for the laboratory test that analyzes a patient’s serum for allergen-specific immunoglobulin E (IgE) using crude allergen extract. The test result is either quantitative or semiquantitative. This code is used for each crude allergen extract tested and is often ordered when a patient is suspected of having an allergy to food, drugs, or environmental agents.

2. 86003 CPT code description

The official description of CPT code 86003 is: “Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each.”

3. Procedure

The 86003 procedure involves the following steps:

1. The lab analyst collects the patient’s serum sample.
2. The serum is mixed with a specific antigen or allergen.
3. If the IgE antibody for that specific allergen is present in the patient’s serum sample, a reaction will occur, binding the antigen or allergen to the IgE antibody.
4. The analyst adds a reagent that changes color if the antigen-antibody complex is present.
5. The color change is measured by a machine, providing a quantitative or semiquantitative result based on the intensity of the color change.
6. The process takes several hours to several days to complete.
7. Report this code for testing of each single crude allergen extract.

4. Qualifying circumstances

Patients who are suspected of having an allergy to food, drugs, or environmental agents may be eligible to receive CPT code 86003 services. Providers may order this test to help diagnose and manage allergies in patients. However, payers may have specific guidelines and restrictions on coverage, such as limiting the number of units that can be reported or only covering the test for young children.

5. When to use CPT code 86003

It is appropriate to bill the 86003 CPT code when a patient is suspected of having an allergy and requires a quantitative or semiquantitative allergen-specific IgE test using crude allergen extract. This code should be used for each crude allergen extract tested. It is important to check payer guidelines and restrictions before billing this code.

6. Documentation requirements

To support a claim for CPT 86003, the following information should be documented:

• Patient’s medical history and symptoms indicating a possible allergy.
• Specific allergens tested using crude allergen extract.
• Method used for the allergen-specific IgE test (e.g., ELISA, RAST, or FAST).
• Quantitative or semiquantitative results of the test.
• Interpretation of the test results and their relevance to the patient’s condition.
• Any additional tests or treatments recommended based on the results.

7. Billing guidelines

When billing for CPT code 86003, it is essential to follow payer guidelines and restrictions. Many payers either do not cover this code, limit coverage to young children, or restrict the number of units that can be reported. Additionally, some payers may pay separately for collecting the specimen using a code such as 36415. It is crucial to verify coverage and billing requirements with the specific payer before submitting a claim.

8. Historical information

CPT 86003 was added to the Current Procedural Terminology system on January 1, 1994. The code was changed on January 1, 2018, with the previous descriptor being “Allergen specific IgE; quantitative or semiquantitative, each allergen.”

9. Similar codes to CPT 86003

Five similar codes to CPT 86003 and how they differentiate are:

• CPT 86008: This code is used for allergen-specific IgE testing using recombinant or purified allergen components instead of crude allergen extract.
• CPT 82785: This code is used for total quantitative IgE testing, not allergen-specific IgE testing.
• CPT 95004: This code is for percutaneous allergy tests performed in an office setting, not for quantitative or semiquantitative lab tests.
• CPT 86001: This code is for allergen-specific IgG testing, not IgE testing.
• CPT 86005: This code is for allergen-specific IgE testing using allergenic extract mixtures, not single crude allergen extracts.

10. Examples

Here are 10 detailed examples of CPT code 86003 procedures:

1. A patient with suspected peanut allergy undergoes an allergen-specific IgE test using crude peanut allergen extract.
2. A patient with a history of seasonal allergies is tested for allergen-specific IgE to grass pollen using crude allergen extract.
3. A child with suspected milk allergy undergoes an allergen-specific IgE test using crude cow’s milk allergen extract.
4. A patient with a suspected drug allergy is tested for allergen-specific IgE to penicillin using crude allergen extract.
5. A patient with suspected pet allergies is tested for allergen-specific IgE to cat dander using crude allergen extract.
6. A patient with a history of insect sting reactions is tested for allergen-specific IgE to bee venom using crude allergen extract.
7. A patient with suspected mold allergy undergoes an allergen-specific IgE test using crude mold allergen extract.
8. A patient with a suspected latex allergy is tested for allergen-specific IgE to latex proteins using crude allergen extract.
9. A patient with a history of food allergies is tested for allergen-specific IgE to egg proteins using crude allergen extract.
10. A patient with suspected environmental allergies is tested for allergen-specific IgE to dust mite allergens using crude allergen extract.