How To Use CPT Code 86231

CPT 86231 describes a specific test that helps identify the presence of endomysial antibodies (EMA) in a patient’s specimen, such as serum. 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 86231?

CPT 86231 can be used to identify the presence of endomysial antibodies (EMA) in a patient’s specimen, such as serum. This test helps in diagnosing autoimmune disorders like celiac disease and dermatitis herpetiformis. It is typically performed using an immunoassay method, such as an indirect immunofluorescence assay (IFA), which involves incubating the serum with a fluorescence-marked antigen to detect the presence of EMA IgG or EMA IgA.

2. Official Description

The official description of CPT code 86231 is: ‘Endomysial antibody (EMA), each immunoglobulin (Ig) class.’

3. Procedure

1. The lab analyst screens the patient’s specimen, such as serum, for the presence or absence of endomysial antibodies (EMA) using an immunoassay method, such as an indirect immunofluorescence assay (IFA).
2. The analyst incubates the serum on a substrate with a fluorescence-marked antigen, such as anti-EMA IgG or anti-EMA IgA.
3. The bound antigen/antibody complex is interpreted using a method like fluorescence microscopy to determine the presence or absence of the antibody in the specimen.

4. Qualifying circumstances

CPT 86231 is typically ordered by clinicians to aid in the diagnosis of autoimmune disorders such as celiac disease or dermatitis herpetiformis. It is important to note that this test is not limited to these specific conditions and may be used in other clinical scenarios where the presence of endomysial antibodies is relevant.

5. When to use CPT code 86231

CPT code 86231 should be used when there is a need to identify the presence of endomysial antibodies (EMA) in a patient’s specimen, such as serum. It is important to use this specific code rather than less-specific codes like 86255 or 83516 to accurately describe the test being performed.

6. Documentation requirements

To support a claim for CPT 86231, the following documentation should be included:

• Indication for the test and the suspected autoimmune disorder
• Details of the specific endomysial antibody (EMA) class being tested (e.g., EMA IgG or EMA IgA)
• Date and time of the test
• Method used for the test, such as indirect immunofluorescence assay (IFA)
• Interpretation of the test results
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86231, ensure that the test is performed to identify the presence of endomysial antibodies (EMA) in the patient’s specimen. It is important to use this specific code rather than less-specific codes. Some payers may also provide separate reimbursement for specimen collection.

8. Historical information

CPT 86231 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 with suspected celiac disease undergoes a test to identify the presence of endomysial antibodies (EMA) in their serum specimen using CPT code 86231.
2. A dermatologist orders a test to detect the presence of endomysial antibodies (EMA) in a patient’s specimen to aid in the diagnosis of dermatitis herpetiformis, using CPT code 86231.
3. A gastroenterologist performs a test to identify the presence of endomysial antibodies (EMA) in a patient’s serum specimen to monitor their adherence to celiac disease treatment, using CPT code 86231.
4. A rheumatologist orders a test to detect the presence of endomysial antibodies (EMA) in a patient’s specimen to investigate possible autoimmune disorders, using CPT code 86231.
5. A primary care physician orders a test to identify the presence of endomysial antibodies (EMA) in a patient’s serum specimen to rule out celiac disease, using CPT code 86231.
6. A patient with recurring skin rash undergoes a test to detect the presence of endomysial antibodies (EMA) in their specimen to aid in the diagnosis of dermatitis herpetiformis, using CPT code 86231.
7. A gastroenterologist performs a test to identify the presence of endomysial antibodies (EMA) in a patient’s serum specimen to monitor their response to celiac disease treatment, using CPT code 86231.
8. A dermatologist orders a test to detect the presence of endomysial antibodies (EMA) in a patient’s specimen to investigate possible autoimmune disorders, using CPT code 86231.
9. A rheumatologist performs a test to identify the presence of endomysial antibodies (EMA) in a patient’s serum specimen to rule out celiac disease, using CPT code 86231.