How To Use CPT Code 86226

CPT 86226 describes the evaluation of a patient’s serum for antibodies to single stranded deoxyribonucleic acid (DNA), also known as ssDNA. 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 86226?

CPT 86226 can be used to evaluate a patient’s serum for antibodies to single stranded DNA. This code is used when a lab analyst performs an immunoassay method, such as enzyme linked immunosorbent assay (ELISA), to test the patient’s serum for ssDNA antibodies. The test involves various steps, including reacting the specimen with test antigens, incubating the mixture, adding an agent to detect the antigen-antibody complex, and interpreting the results.

2. Official Description

The official description of CPT code 86226 is: ‘Deoxyribonucleic acid (DNA) antibody; single stranded.’

3. Procedure

1. The lab analyst collects a serum sample from the patient.
2. The analyst performs an immunoassay method, such as ELISA, to test the patient’s serum for ssDNA antibodies.
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 86226 is typically ordered by a clinician to diagnose and monitor patients with autoimmune diseases such as lupus erythematosus (LE). Single stranded DNA antibodies are autoantibodies that may also occur in diseases of connective tissue, leukemia, and infectious mononucleosis. The test is performed on the patient’s serum using an immunoassay method.

5. When to use CPT code 86226

CPT code 86226 should be used when a clinician orders the evaluation of a patient’s serum for antibodies to single stranded DNA. It is appropriate for diagnosing and monitoring autoimmune diseases, such as lupus erythematosus, and other conditions where single stranded DNA antibodies may be present.

6. Documentation requirements

To support a claim for CPT 86226, the documentation should include:

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

7. Billing guidelines

When billing for CPT 86226, ensure that the test is performed by a lab analyst using an immunoassay method. It is important to follow the specific guidelines provided by the payer regarding documentation and coding requirements. Some payers may also separately reimburse for specimen collection using a different code.

8. Historical information

CPT 86226 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 clinician orders CPT 86226 to evaluate a patient’s serum for antibodies to single stranded DNA as part of the diagnostic workup for lupus erythematosus.
2. A patient with suspected autoimmune disease undergoes CPT 86226 to assess the presence of single stranded DNA antibodies.
3. CPT 86226 is performed on a patient’s serum to monitor the progression of an autoimmune disease.
4. A clinician orders CPT 86226 to evaluate a patient’s serum for single stranded DNA antibodies as part of the differential diagnosis for connective tissue diseases.
5. A patient with a history of leukemia undergoes CPT 86226 to assess the presence of single stranded DNA antibodies.
6. CPT 86226 is performed on a patient’s serum to rule out infectious mononucleosis.
7. A clinician orders CPT 86226 to evaluate a patient’s serum for single stranded DNA antibodies as part of the diagnostic workup for systemic sclerosis.
8. A patient with suspected autoimmune disease undergoes CPT 86226 to assess the presence of single stranded DNA antibodies.
9. CPT 86226 is performed on a patient’s serum to monitor the response to treatment for an autoimmune disease.
10. A clinician orders CPT 86226 to evaluate a patient’s serum for single stranded DNA antibodies as part of the diagnostic workup for leukemia.