How To Use CPT Code 86200

CPT 86200 describes the detection of cyclic citrullinated peptide (CCP) antibodies in serum using an immunoassay. 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 86200?

CPT 86200 can be used to detect cyclic citrullinated peptide (CCP) antibodies in serum. This code is used when a lab analyst performs a technical lab test to identify CCP antibodies, typically in serum, using an immunoassay such as enzyme-linked immunosorbent assay (ELISA). The results of this test can help differentiate rheumatoid arthritis (RA) from other forms of arthritis.

2. Official Description

The official description of CPT code 86200 is: ‘Cyclic citrullinated peptide (CCP), antibody.’

3. Procedure

1. The lab analyst collects a serum sample from the patient.
2. The analyst adds the serum to wells on a microtiter plate that contains synthetic CCP.
3. The plate is incubated to allow any CCP antibodies present in the patient sample to bind to the synthetic CCP.
4. An enzyme is added to the wells, which attaches to the antigen-antibody complex.
5. The analyst uses an automated reader with a spectrophotometer to measure the light intensity of a specific wavelength that the sample transmits.
6. The results of the test commonly show as negative, weak positive, positive, or strong positive.

4. Qualifying circumstances

CPT 86200 is typically ordered by a clinician to diagnose early stages of rheumatoid arthritis (RA). The test has higher sensitivity and specificity for RA compared to other tests, which may still show negative results even in the presence of RA. The test is performed on serum samples and requires the presence of CCP antibodies for accurate detection.

5. When to use CPT code 86200

CPT code 86200 should be used when a lab analyst performs a test to detect CCP antibodies in serum using an immunoassay. This code is appropriate when the test is specifically ordered to aid in the diagnosis of rheumatoid arthritis or to differentiate RA from other forms of arthritis.

6. Documentation requirements

To support a claim for CPT 86200, the documentation should include:

• Order for the test from the clinician
• Identification of the patient
• Date and time of the test
• Results of the test, including the interpretation of negative, weak positive, positive, or strong positive
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86200, ensure that the test is performed by a lab analyst and that the appropriate documentation is provided. It is important to note that some payers may separately reimburse for the collection of the serum sample using a different code, such as 36415 for venous blood collection by venipuncture. It is also important to review payer-specific guidelines for any additional requirements or modifiers that may be necessary for accurate billing.

8. Historical information

CPT 86200 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs CPT 86200 to detect CCP antibodies in the serum of a patient with suspected rheumatoid arthritis.
2. A clinician orders CPT 86200 to differentiate between rheumatoid arthritis and other forms of arthritis in a patient with joint pain and inflammation.
3. A patient with a family history of rheumatoid arthritis undergoes CPT 86200 to assess their risk for developing the condition.
4. A rheumatologist orders CPT 86200 as part of a comprehensive diagnostic panel for a patient with symptoms suggestive of rheumatoid arthritis.
5. A patient with persistent joint swelling and morning stiffness undergoes CPT 86200 to aid in the diagnosis of rheumatoid arthritis.
6. A lab analyst performs CPT 86200 to monitor the levels of CCP antibodies in a patient with known rheumatoid arthritis.
7. A patient with a positive rheumatoid factor test undergoes CPT 86200 to confirm the presence of CCP antibodies and further support the diagnosis of rheumatoid arthritis.
8. A clinician orders CPT 86200 to assess the effectiveness of a new treatment for rheumatoid arthritis by monitoring changes in CCP antibody levels over time.
9. A patient with joint pain and swelling undergoes CPT 86200 to rule out rheumatoid arthritis as the cause of their symptoms.
10. A lab analyst performs CPT 86200 as part of a routine screening for rheumatoid arthritis in a high-risk population.