How To Use CPT Code 86051

CPT 86051 describes a test that detects the presence of aquaporin-4 (AQP4) antibodies in a serum specimen using an enzyme-linked immunosorbent assay (ELISA). This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86051?

CPT 86051 can be used to identify the presence of aquaporin-4 (AQP4) antibodies in a serum specimen. This test is performed using an enzyme-linked immunosorbent assay (ELISA) method. The presence of AQP4 antibodies is an important marker for neuromyelitis optica (NMO), an autoimmune disease that affects the optic nerve, brain stem, and spinal cord. It is crucial in distinguishing NMO from multiple sclerosis (MS), as both conditions may present similar symptoms.

2. Official Description

The official description of CPT code 86051 is: ‘Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-linked immunosorbent immunoassay (ELISA).’ This code specifically refers to the detection of AQP4 antibodies using the ELISA method.

3. Procedure

1. The laboratory analyst performs an ELISA test to detect the presence of AQP4 antibodies in a serum specimen.
2. The ELISA method utilizes an enzyme-labeled antigen or antibody that reacts with the AQP4 antibodies in the specimen, resulting in a measurable change.
3. The test is performed on a serum specimen obtained from the patient.
4. The presence and possibly the level of AQP4 antibodies are determined based on the reaction observed in the ELISA test.
5. The results of the test help in the differential diagnosis of NMO, distinguishing it from MS.

4. Qualifying circumstances

CPT 86051 is used when there is a need to detect the presence of AQP4 antibodies in a serum specimen. This test is typically ordered by clinicians to aid in the differential diagnosis of NMO and MS. Patients suspected of having NMO, characterized by optic nerve involvement and possible brain stem and spinal cord damage, may undergo this test to confirm the presence of AQP4 antibodies. The test is performed on a serum specimen obtained from the patient.

5. When to use CPT code 86051

CPT code 86051 should be used when there is a clinical suspicion of NMO and the clinician wants to confirm the presence of AQP4 antibodies. This test helps differentiate NMO from MS, as the presence of AQP4 antibodies is more specific to NMO. It is important to note that CPT code 86051 should not be used for less specific antibody tests or for other purposes unrelated to the detection of AQP4 antibodies.

6. Documentation requirements

To support a claim for CPT code 86051, the following documentation is required:

• Indication for the test, such as suspicion of NMO
• Details of the serum specimen used for testing
• Results of the ELISA test, including the presence and level of AQP4 antibodies
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT code 86051, ensure that the test is performed using the ELISA method to detect AQP4 antibodies. It is important to use the correct code for the specific lab method. Additionally, consider any specific payer guidelines and requirements for reporting this code. It is also important to note that CPT code 86051 should not be reported with less specific codes or unrelated codes.

8. Historical information

CPT code 86051 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient suspected of having NMO undergoes a test to detect the presence of AQP4 antibodies using the ELISA method.
2. A neurologist orders CPT code 86051 to confirm the diagnosis of NMO in a patient with optic nerve involvement.
3. A serum specimen is collected from a patient with suspected NMO, and the ELISA test is performed to detect AQP4 antibodies.
4. A positive result for AQP4 antibodies using the ELISA method helps differentiate NMO from MS in a patient with similar symptoms.
5. A laboratory analyst performs an ELISA test on a serum specimen to determine the presence and level of AQP4 antibodies in a patient suspected of having NMO.
6. CPT code 86051 is used to detect AQP4 antibodies in a serum specimen obtained from a patient with clinical signs and symptoms consistent with NMO.
7. A neurologist orders CPT code 86051 to confirm the presence of AQP4 antibodies in a patient with suspected NMO.
8. The ELISA test using CPT code 86051 is performed on a serum specimen to aid in the differential diagnosis of NMO and MS.
9. A positive result for AQP4 antibodies using the ELISA method supports the diagnosis of NMO in a patient with optic nerve involvement.
10. CPT code 86051 is used to detect the presence of AQP4 antibodies in a serum specimen, helping to distinguish NMO from MS in a patient with similar symptoms.