How To Use CPT Code 86225

CPT 86225 describes the evaluation of a patient’s serum for antibodies to native or double-stranded deoxyribonucleic acid (DNA). 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 86225?

CPT 86225 can be used to evaluate a patient’s serum for antibodies to native or double-stranded DNA. This code is used when a lab analyst performs an assay to test for the presence of these antibodies using an immunoassay method, such as enzyme-linked immunosorbent assay (ELISA).

2. Official Description

The official description of CPT code 86225 is: ‘Deoxyribonucleic acid (DNA) antibody; native or double-stranded.’

3. Procedure

1. The lab analyst collects a serum sample from the patient.
2. The serum sample is tested for the presence of antibodies to native or double-stranded DNA using an immunoassay method, such as ELISA.
3. The test may involve reacting the specimen with test antigens, incubating the mixture, adding an agent to detect the antigen-antibody complex, and interpreting the results.
4. The results are reported as positive, negative, or as a semiquantitative value.

4. Qualifying circumstances

CPT 86225 is typically ordered by a clinician to diagnose patients with the autoimmune disease lupus erythematosus (LE) or to monitor the treatment of patients with confirmed LE. The presence of antibodies to native or double-stranded DNA is associated with inflammation flare-ups, particularly in the kidneys. The levels of these antibodies may increase before a flare-up and decrease with successful treatment.

5. When to use CPT code 86225

CPT code 86225 should be used when a lab analyst performs an assay to evaluate a patient’s serum for antibodies to native or double-stranded DNA. This code is appropriate for diagnosing or monitoring patients with autoimmune diseases, such as lupus erythematosus.

6. Documentation requirements

To support a claim for CPT 86225, the documentation should include:

• Reason for ordering the test, such as suspected autoimmune disease or monitoring of treatment
• Details of the immunoassay method used, such as ELISA
• Date of the test
• Results of the test, reported as positive, negative, or semiquantitative

7. Billing guidelines

When billing for CPT 86225, ensure that the test is performed by a lab analyst using an immunoassay method to evaluate the patient’s serum for antibodies to native or double-stranded DNA. There are no specific guidelines regarding reporting this code with other codes.

8. Historical information

CPT 86225 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 performs an immunoassay to evaluate a patient’s serum for antibodies to native or double-stranded DNA, and the results are reported as positive for lupus erythematosus.
2. A clinician orders CPT 86225 to monitor the treatment of a patient with confirmed lupus erythematosus, and the test shows a decrease in the levels of antibodies to native or double-stranded DNA.
3. A patient with suspected autoimmune disease undergoes CPT 86225, and the test results are negative for antibodies to native or double-stranded DNA.
4. A lab analyst performs an immunoassay to evaluate a patient’s serum for antibodies to native or double-stranded DNA, and the results show a semiquantitative value indicating a moderate level of antibodies.
5. A clinician orders CPT 86225 to diagnose a patient with suspected lupus erythematosus, and the test results are positive for antibodies to native or double-stranded DNA.