How To Use CPT Code 86038

CPT 86038 describes the analysis of antinuclear antibodies (ANA) in the serum by a lab analyst. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86038?

CPT 86038 can be used to describe the lab test performed by a lab analyst to analyze the presence of antinuclear antibodies (ANA) in the serum. This test helps in identifying autoimmune disorders by detecting antibodies that target the normal proteins within the nucleus of a cell.

2. Official Description

The official description of CPT code 86038 is: ‘The lab analyst performs the technical lab test to analyze for the presence of antinuclear antibodies in the serum; these are antibodies to the nucleus of a human cell.’

3. Procedure

1. The lab analyst receives the patient’s blood sample, specifically the serum, for analysis.
2. The analyst performs the technical steps to evaluate the presence of antinuclear antibodies (ANAs) in the serum.
3. The most commonly used test for detecting ANA is the fluorescent antinuclear antibody (FANA) test.
4. The analyst mixes the patient’s serum with nuclear antigens and attaches a fluorescent label to make the antigen-antibody complex visible under the microscope.
5. The analyst examines the sample under the microscope to determine the presence and patterns of ANAs.
6. Elevated levels of ANAs in the serum may indicate the presence of autoimmune diseases.

4. Qualifying circumstances

CPT 86038 is performed when there is a suspicion of an autoimmune disorder. Symptoms that may lead to ordering this test include muscle aches and pain, swollen glands, weakness, frequent infections, and swelling. The test helps in confirming the presence of antinuclear antibodies (ANAs) in the patient’s serum, which are characteristic of autoimmune diseases.

5. When to use CPT code 86038

CPT code 86038 should be used when a lab analyst performs the analysis of antinuclear antibodies (ANAs) in the patient’s serum. It is appropriate to bill this code when there is a clinical suspicion of an autoimmune disorder and the test is ordered to confirm the presence of ANAs.

6. Documentation requirements

To support a claim for CPT 86038, the documentation should include:

• Reason for ordering the test, such as suspicion of an autoimmune disorder
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including the presence and patterns of antinuclear antibodies (ANAs)
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86038, ensure that the test is performed by a lab analyst and that the analysis is done on the patient’s serum. This code should not be reported with other codes unless specifically required by the payer. It is important to follow any additional guidelines provided by the payer for accurate billing.

8. Historical information

CPT 86038 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the analysis of antinuclear antibodies (ANAs) in the serum of a patient suspected to have systemic lupus erythematosus (SLE).
2. An analyst using the fluorescent antinuclear antibody (FANA) test to detect the presence of ANAs in the serum of a patient with suspected scleroderma.
3. A lab performing the analysis of ANAs in the serum of a patient with symptoms of polymyositis.
4. An analyst examining the patient’s serum for the presence of ANAs to confirm the diagnosis of an autoimmune hepatitis.
5. A lab technician performing the analysis of ANAs in the serum of a patient with unexplained muscle weakness and joint pain.
6. An analyst using the FANA test to detect the presence of ANAs in the serum of a patient with suspected autoimmune disorder.
7. A lab performing the analysis of ANAs in the serum of a patient with symptoms of an autoimmune disorder.
8. An analyst examining the patient’s serum for the presence of ANAs to investigate the cause of recurrent infections.
9. A lab technician performing the analysis of ANAs in the serum of a patient with unexplained swelling and fatigue.
10. An analyst using the FANA test to detect the presence of ANAs in the serum of a patient with suspected autoimmune disorder.