How To Use CPT Code 86005

CPT 86005 describes the qualitative or semiquantitative immunoassays used to analyze for the presence of allergen specific immunoglobulin E (IgE) using a multi-allergen screening tool. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86005?

CPT 86005 can be used to describe the qualitative or semiquantitative immunoassays performed to detect the presence of allergen specific IgE in a patient’s serum. This test utilizes a multi-allergen screening tool, such as a disk, sponge, card, or other kit device, to provide a qualitative result. It is commonly ordered when there is a suspicion of an allergic condition and the specific allergens need to be identified.

2. Official Description

The official description of CPT code 86005 is: ‘Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card)’. This code is used to indicate the performance of a qualitative or semiquantitative immunoassay to detect allergen specific IgE using a multi-allergen screening tool.

3. Procedure

1. The lab analyst performs the technical steps to detect the presence of allergen specific IgE in the patient’s serum.
2. A multi-allergen screening tool, such as a disk, sponge, card, or other kit device, is used to conduct the immunoassay.
3. The analyst places the patient’s serum on each testing pad of the screening tool, which is coated with different allergens.
4. A color reaction occurs on the testing pads if allergen specific IgE is present in the patient’s serum.
5. The presence or absence of allergen specific IgE is determined based on the color reaction observed.

4. Qualifying circumstances

CPT 86005 is performed when there is a suspicion of an allergic condition and the specific allergens need to be identified. It is especially useful in cases where direct skin testing and allergic reactions may be problematic, such as in small children with widespread skin disease. The test is performed on serum samples, and the results provide qualitative or semiquantitative information about the presence of allergen specific IgE.

5. When to use CPT code 86005

CPT code 86005 should be used when a qualitative or semiquantitative immunoassay is performed to detect the presence of allergen specific IgE using a multi-allergen screening tool. It is appropriate to use this code when there is a suspicion of an allergic condition and the specific allergens need to be identified. This code should not be used for quantitative measurements of allergen specific IgE.

6. Documentation requirements

To support a claim for CPT code 86005, the following documentation is required:

• Reason for ordering the test, indicating the suspicion of an allergic condition
• Details of the multi-allergen screening tool used
• Date of the test
• Results of the qualitative or semiquantitative immunoassay
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 86005, ensure that the test is performed using a multi-allergen screening tool and provides a qualitative or semiquantitative result. It is important to note that this code should not be reported with other codes for quantitative measurements of allergen specific IgE. Additionally, some payers may provide separate reimbursement for specimen collection using a code such as 36415.

8. Historical information

CPT code 86005 was added to the Current Procedural Terminology system on January 1, 1994. Since then, there have been a few changes to the code description, including updates to the terminology used to describe the multi-allergen screening tool.

9. Examples

1. A patient presents with symptoms of allergic rhinitis, and the physician orders CPT code 86005 to identify the specific allergens causing the condition.
2. A child with eczema and widespread skin lesions undergoes CPT code 86005 to determine the allergens triggering the skin disease.
3. A patient with suspected food allergies undergoes CPT code 86005 to identify the specific allergens causing adverse reactions.
4. A healthcare provider orders CPT code 86005 for a patient with suspected environmental allergies to identify the specific allergens responsible for the symptoms.
5. A patient with a history of allergic reactions undergoes CPT code 86005 to determine the specific allergens causing the reactions.
6. A physician orders CPT code 86005 for a patient with suspected drug allergies to identify the specific allergens causing adverse reactions.
7. A child with recurrent hives undergoes CPT code 86005 to identify the specific allergens triggering the hives.
8. A patient with suspected insect allergies undergoes CPT code 86005 to determine the specific allergens responsible for the reactions.
9. A healthcare provider orders CPT code 86005 for a patient with suspected pet allergies to identify the specific allergens causing the symptoms.
10. A patient with a history of anaphylaxis undergoes CPT code 86005 to determine the specific allergens responsible for the severe allergic reactions.