How To Use CPT Code 86769
CPT 86769 is a code used for antibody testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 86769.
1. What is CPT 86769?
CPT 86769 is a code used by medical professionals to bill for the laboratory testing of a patient’s blood or serum for the presence of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19). This test is performed using a multiple-step immunoassay method, such as enzyme-linked immunosorbent assay (ELISA), to evaluate the patient’s immune response to the virus.
2. 86769 CPT code description
The official description of CPT code 86769 is: “Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])”.
The procedure for CPT 86769 involves the following steps:
- Collection of the patient’s blood or serum sample.
- Preparation of the sample for testing, which may include centrifugation or other processing methods.
- Performing the multiple-step immunoassay, such as ELISA, to detect the presence of SARS-CoV-2 antibodies in the sample.
- Incubating the mixture and adding an agent to detect the antigen-antibody complex, such as a stain or fluorescent marker.
- Interpreting the results as positive, negative, or a semiquantitative value.
4. Qualifying circumstances
Patients who are eligible to receive CPT code 86769 services include those who:
- Have a history of COVID-19 infection or exposure to the virus.
- Are being evaluated for a past SARS-CoV-2 infection for follow-up care.
- Are being screened for potential blood plasma donation to treat current COVID-19 patients.
- Require antibody testing for other clinical reasons, as determined by their healthcare provider.
5. When to use CPT code 86769
It is appropriate to bill the 86769 CPT code when a healthcare provider orders a multiple-step immunoassay test to evaluate a patient’s serum for antibodies to SARS-CoV-2. This test may be ordered for various reasons, such as assessing a patient’s immune response to a past infection, screening for potential blood plasma donors, or for other clinical purposes as determined by the provider.
6. Documentation requirements
To support a claim for CPT 86769, the following information should be documented:
- Patient’s demographic information, including name, date of birth, and insurance information.
- Medical history and relevant clinical information, such as symptoms, exposure history, or previous COVID-19 diagnosis.
- Order for the SARS-CoV-2 antibody test, including the specific test method (e.g., ELISA) and the reason for the test.
- Results of the test, including the interpretation as positive, negative, or a semiquantitative value.
- Any follow-up care or treatment recommendations based on the test results.
7. Billing guidelines
When billing for CPT code 86769, keep in mind the following guidelines and tips:
- If multiple assays are performed for different classes of antibodies (e.g., IgG and IgM), report 86769 x 2 and append an appropriate modifier, such as 59, to the second code.
- For SARS-CoV-2 DNA or RNA detection by nucleic acid, amplified probe technique, use CPT code 87635.
- For SARS-CoV-2 antigen detection by immunoassay, use CPT code 87426.
- For HCPCS codes for laboratory testing for the SARS-CoV-2 virus, see U0001 (specifically for the CDC-developed kit) and U0002 (for tests developed by other labs).
- Some payers may pay separately for collecting the specimen using a code such as 36415.
8. Historical information
CPT 86769 was added to the Current Procedural Terminology system on April 10, 2020. There have been no updates to the code since its addition.
9. Similar codes to CPT 86769
Five similar codes to CPT 86769 and how they differ are:
- CPT 86328: This code is used for SARS-CoV-2 antibody testing using a single-step immunoassay method, such as a reagent strip, which may be used for point-of-care testing.
- CPT 86710: This is the parent code for 86769 and is used for antibody testing for other infectious agents.
- CPT 87635: This code is used for SARS-CoV-2 DNA or RNA detection by nucleic acid, amplified probe technique.
- CPT 87426: This code is used for SARS-CoV-2 antigen detection by immunoassay.
- HCPCS U0001 and U0002: These codes are used for laboratory testing for the SARS-CoV-2 virus, with U0001 specifically for the CDC-developed kit and U0002 for tests developed by other labs.
Here are 10 detailed examples of CPT code 86769 procedures:
- A patient with a history of COVID-19 infection requires antibody testing to determine their immune response to the virus.
- A healthcare worker who was exposed to COVID-19 patients undergoes antibody testing to assess their immunity.
- A patient who recovered from a mild case of COVID-19 is tested for antibodies to determine their eligibility for blood plasma donation.
- A patient with a suspected past asymptomatic SARS-CoV-2 infection undergoes antibody testing for follow-up care and monitoring.
- A patient with a history of COVID-19 infection and ongoing symptoms undergoes antibody testing to assess their immune response and guide further treatment.
- A patient with a high-risk occupation, such as a first responder, undergoes antibody testing to determine their immunity to SARS-CoV-2.
- A patient who was previously diagnosed with COVID-19 and has since recovered undergoes antibody testing as part of a research study on the immune response to the virus.
- A patient with a history of COVID-19 infection undergoes antibody testing to assess their immune response before receiving a COVID-19 vaccine.
- A patient with a suspected false-negative PCR test result for COVID-19 undergoes antibody testing to confirm a past infection.
- A patient with a history of COVID-19 infection undergoes antibody testing as part of a clinical trial for a new treatment or vaccine.