How To Use CPT Code 86480

CPT 86480 is a tuberculosis test that measures cell-mediated immunity antigen response to gamma interferon. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT code 86480 procedures.

1. What is CPT 86480?

CPT 86480 is a laboratory test used to evaluate a patient’s cell-mediated immunity gamma interferon antigen response to certain tuberculosis (TB) antibodies. This test is particularly useful in diagnosing latent tuberculosis infection (LTBI) and active TB disease. It is an indirect assay for infection with Mycobacterium tuberculosis complex and is less likely to result in false positives compared to other TB tests.

2. 86480 CPT code description

The official description of CPT code 86480 is: “Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon.”

3. Procedure

The procedure for CPT 86480 involves the following steps:

1. Collecting a blood specimen from the patient.
2. Mixing the whole blood with TB-specific antigens.
3. Measuring the gamma interferon secretion using an enzyme-linked immunosorbent assay (ELISA) technique.
4. Evaluating the specific T cell response, called cell-mediated immune response, to the TB antigens.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 86480 services include those who:

• Have been exposed to someone with active TB disease.
• Have a weakened immune system due to conditions such as HIV/AIDS, organ transplantation, or immunosuppressive therapy.
• Are healthcare workers or other individuals at high risk of TB exposure.
• Have a history of TB infection or disease and require monitoring for reactivation.
• Are immigrants from countries with high TB prevalence.

5. When to use CPT code 86480

It is appropriate to bill the 86480 CPT code when a healthcare provider orders the test to evaluate a patient’s cell-mediated immunity gamma interferon antigen response to TB antibodies. This test is particularly useful in diagnosing LTBI and active TB disease, as well as monitoring patients with a history of TB infection or disease for reactivation.

6. Documentation requirements

To support a claim for CPT 86480, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Medical history, including any known risk factors for TB exposure or infection.
• Physical examination findings, if applicable.
• Indication for the test, such as suspected LTBI, active TB disease, or monitoring for reactivation.
• Order for the test, including the date and the healthcare provider’s signature.
• Results of the test, including the gamma interferon level and interpretation of the results.

7. Billing guidelines

When billing for CPT code 86480, it is important to follow the appropriate guidelines and rules. Some payers may pay separately for collecting the specimen using a code such as 36415 for venipuncture. Additionally, it is crucial to distinguish CPT 86480 for gamma interferon antigen response from CPT 86481 for enumeration of gamma interferon-producing T cells.

8. Historical information

CPT 86480 was added to the Current Procedural Terminology system on January 1, 2011. The previous descriptor for this code was “Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response.”

9. Similar codes to CPT 86480

Five similar codes to CPT 86480 and how they differentiate from CPT 86480 are:

1. CPT 86481: This code is used for enumeration of gamma interferon-producing T cells, rather than measuring the antigen response.
2. CPT 86580: This code is used for a skin test to detect TB infection, which may result in more false positives compared to CPT 86480.
3. CPT 86590: This code is used for a serologic test for syphilis, not for TB testing.
4. CPT 86631: This code is used for an antibody test for Chlamydia, not for TB testing.
5. CPT 86635: This code is used for an antibody test for Rickettsia, not for TB testing.

10. Examples

Here are 10 detailed examples of CPT code 86480 procedures:

1. A healthcare worker with a known TB exposure undergoes CPT 86480 testing to evaluate for LTBI.
2. A patient with HIV and a history of TB infection receives CPT 86480 testing to monitor for reactivation of the disease.
3. An immigrant from a high TB prevalence country undergoes CPT 86480 testing as part of a routine health screening.
4. A patient with a weakened immune system due to immunosuppressive therapy receives CPT 86480 testing to evaluate for LTBI.
5. A patient with a history of organ transplantation undergoes CPT 86480 testing to assess for TB infection.
6. A patient with a persistent cough and weight loss receives CPT 86480 testing to evaluate for active TB disease.
7. A healthcare provider orders CPT 86480 testing for a patient with a positive TB skin test to confirm the diagnosis of LTBI.
8. A patient with a history of TB disease and recent close contact with an individual with active TB undergoes CPT 86480 testing to assess for reactivation.
9. A patient with a positive TB skin test and a history of Bacillus Calmette-Guerin (BCG) vaccination receives CPT 86480 testing to rule out a false positive result.
10. A healthcare worker with a history of TB infection undergoes routine CPT 86480 testing to monitor for reactivation of the disease.