How To Use CPT Code 86161

CPT 86161 describes the measurement of functional activity of complement components, such as C1 through C9, which play a crucial role in detecting and fighting infection. 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 86161?

CPT 86161 can be used to measure the functional activity of complement components, specifically C1 through C9. These components are essential in the body’s immune response to infection. The test evaluates autoimmune conditions, which are diseases that produce antibodies against the body’s own cells and tissues.

2. Official Description

The official description of CPT code 86161 is: ‘Complement; functional activity, each component.’

3. Procedure

1. The lab analyst performs a technical test to measure the functional activity of complement components.
2. The analyst typically mixes complement-depleted serum with the patient’s serum to determine if the patient’s serum corrects the deficiency.
3. Other tests, such as functional C1 esterase inhibitor, may use enzyme immunoassay (EIA) to detect antigen-antibody complexes.
4. The complement components work together to activate a response to infection, amplify the response, and destroy infectious material.
5. A decreased function of a specific component may disrupt this process and impair the body’s response to infection.
6. Clinicians may order complement functional activity tests to monitor disease conditions, such as systemic lupus erythematosus (SLE) or rheumatoid arthritis, or to help diagnose recurrent infections or inflammatory bowel disease.

4. Qualifying circumstances

CPT 86161 is performed when there is a need to evaluate the functional activity of complement components. This test is commonly ordered for patients with autoimmune conditions, such as SLE or hereditary angioneurotic edema. It may also be used to monitor disease conditions or diagnose recurrent infections or inflammatory bowel disease.

5. When to use CPT code 86161

CPT code 86161 should be used when there is a clinical need to measure the functional activity of complement components. It is appropriate for patients with autoimmune conditions, those requiring disease monitoring, or those with suspected recurrent infections or inflammatory bowel disease.

6. Documentation requirements

To support a claim for CPT 86161, the following documentation is required:

• Indication of the need for complement functional activity measurement
• Details of the specific complement components tested
• Methodology used for the test
• Date and time of the test
• Results of the test
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86161, ensure that the test is performed to measure the functional activity of complement components. It is important to follow the specific documentation requirements and guidelines provided by the payer. CPT code 86161 should not be reported with other codes unless there are specific circumstances that warrant additional codes.

8. Historical information

CPT 86161 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates to the code since its addition.

9. Examples

1. A patient with systemic lupus erythematosus (SLE) undergoes a complement functional activity test to monitor disease progression.
2. A clinician orders a complement functional activity test for a patient with suspected recurrent infections to evaluate the immune response.
3. A patient with inflammatory bowel disease undergoes a complement functional activity test to aid in the diagnosis and management of the condition.
4. A patient with rheumatoid arthritis undergoes a complement functional activity test to assess the disease activity and response to treatment.
5. A complement functional activity test is performed on a patient with suspected autoimmune conditions to evaluate the immune system’s response to infection.
6. A clinician orders a complement functional activity test for a patient with unexplained symptoms to assess the immune system’s function.
7. A patient with a history of recurrent infections undergoes a complement functional activity test to identify any deficiencies in the immune response.
8. A complement functional activity test is performed on a patient with suspected complement deficiencies to aid in the diagnosis and management of the condition.
9. A clinician orders a complement functional activity test for a patient with suspected autoimmune conditions to evaluate the immune system’s response to infection.
10. A patient with unexplained symptoms undergoes a complement functional activity test to assess the immune system’s function and identify any abnormalities.