How To Use CPT Code 86140

CPT 86140 is a code used for the C-reactive protein test, which helps in the early diagnosis and detection of various inflammatory conditions. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 86140.

1. What is CPT 86140?

CPT 86140 is a code used for the C-reactive protein (CRP) test. CRP is a protein produced by the liver in response to inflammation or infection in the body. The test is used to detect the presence of CRP in a patient’s blood, which can help in the early diagnosis and detection of various inflammatory conditions such as rheumatic fever, rheumatoid arthritis, cancer, or pelvic inflammatory disease.

2. 86140 CPT code description

The official description of CPT code 86140 is: “C-reactive protein.”

3. Procedure

1. A healthcare provider orders the C-reactive protein test for a patient with suspected inflammation or infection.
2. A lab technician collects a blood sample from the patient, typically through venipuncture.
3. The blood sample is sent to a laboratory for analysis.
4. The lab analyst performs the technical lab test to analyze the specimen, typically serum, for the presence of C-reactive protein. Nephelometry is commonly used for detection.
5. The nephelometer measures the scattering of light by proteins in the serum, which can differentiate between different types of proteins based on the way they scatter light.
6. The lab analyst determines if C-reactive protein is present in the patient’s serum and reports the results to the healthcare provider.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 86140 services are those with suspected inflammation or infection, such as rheumatic fever, rheumatoid arthritis, cancer, or pelvic inflammatory disease. Additionally, patients with elevated CRP levels due to later stages of pregnancy, use of birth control pills, hormone replacement therapy, or obesity may also qualify for this test.

5. When to use CPT code 86140

It is appropriate to bill the 86140 CPT code when a healthcare provider orders the C-reactive protein test for a patient with suspected inflammation or infection, or when monitoring a patient’s inflammatory condition. The test can also be used to evaluate the risk of cardiovascular disease by measuring high sensitivity C-reactive protein (hsCRP) levels.

6. Documentation requirements

To support a claim for CPT 86140, the following information needs to be documented:

• Medical necessity for the C-reactive protein test, including the patient’s symptoms, medical history, and suspected condition.
• Order for the test from the healthcare provider.
• Details of the blood sample collection, including the date, time, and method of collection.
• Results of the C-reactive protein test, including the presence or absence of CRP and the level of CRP detected in the patient’s serum.
• Interpretation of the test results by the healthcare provider and any subsequent treatment or management plan.

7. Billing guidelines

When billing for CPT code 86140, it is important to follow the specific guidelines and rules set by the payer. Some payers may pay separately for the collection of the blood sample using a code such as 36415, Collection of venous blood by venipuncture. Additionally, if the healthcare provider orders a high sensitivity C-reactive protein (hsCRP) test, it should be reported using CPT code 86141, C reactive protein; high sensitivity, hsCRP.

8. Historical information

CPT 86140 was added to the Current Procedural Terminology system on January 1, 1990. There have been changes to the code descriptor on January 1, 2002, and January 1, 2010.

9. Similar codes to CPT 86140

Five similar codes to CPT 86140 and how they differentiate from CPT 86140 are:

• CPT 86141: This code is used for high sensitivity C-reactive protein (hsCRP) tests, which detect lower levels of CRP and are important for evaluating the risk of cardiovascular disease.
• CPT 86628: This code is used for the detection of Candidiasis, a fungal infection caused by Candida species.
• CPT 86146: This code is used for the detection of beta-2 glycoprotein I antibodies, which are associated with antiphospholipid syndrome and increased risk of blood clots.
• CPT 86147: This code is used for the detection of cardiolipin antibodies, which are also associated with antiphospholipid syndrome and increased risk of blood clots.
• CPT 86148: This code is used for the detection of phosphatidylserine antibodies, which are associated with autoimmune diseases and increased risk of blood clots.

10. Examples

Here are 10 detailed examples of CPT code 86140 procedures:

1. A patient with suspected rheumatic fever undergoes a C-reactive protein test to confirm the diagnosis.
2. A patient with rheumatoid arthritis has a C-reactive protein test to monitor their inflammatory condition and response to treatment.
3. A patient with unexplained weight loss and fatigue undergoes a C-reactive protein test as part of the diagnostic workup for cancer.
4. A patient with pelvic pain and fever undergoes a C-reactive protein test to diagnose pelvic inflammatory disease.
5. A patient in the later stages of pregnancy has a C-reactive protein test to monitor for potential complications related to inflammation.
6. A patient on hormone replacement therapy undergoes a C-reactive protein test to evaluate their risk of cardiovascular disease.
7. A patient with obesity has a C-reactive protein test to assess their risk of developing inflammatory conditions.
8. A patient with a history of heart disease undergoes a high sensitivity C-reactive protein (hsCRP) test to evaluate their risk of future cardiovascular events.
9. A patient with suspected lupus has a C-reactive protein test to help confirm the diagnosis and assess the severity of the disease.
10. A patient with unexplained joint pain and swelling undergoes a C-reactive protein test as part of the diagnostic workup for inflammatory conditions.