How To Use CPT Code 86235

CPT 86235 describes the evaluation of a patient’s serum for each antibody to an extractable nuclear antigen (ENA). 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 86235?

CPT 86235 can be used to evaluate a patient’s serum for each antibody to an extractable nuclear antigen (ENA). This code is used when a lab analyst performs an assay to test the patient’s serum for specific ENA antibodies, such as anti ribonuclear protein (RNP), anti Sjogren’s Syndrome A and B (SS A and SS B), anti Smith (Sm), and anti scleroderma (Scl 70).

2. Official Description

The official description of CPT code 86235 is: ‘Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody.’

3. Procedure

1. The lab analyst performs an assay to evaluate the patient’s serum for each specific ENA antibody.
2. The assay may involve reacting the specimen with specific antigens bound to microspheres containing a fluorescent dye.
3. An agent is added to detect the antigen-antibody complex.
4. The result is measured by laser photometry that detects the unique microsphere light signature.
5. The result is interpreted as positive, negative, or semiquantitative value.

4. Qualifying circumstances

CPT 86235 is used when a clinician orders the test to help diagnose patients with autoimmune connective tissue disease, typically after receiving a positive antinuclear antigen (ANA) blood test. The test helps distinguish different types of connective tissue disease based on the presence of specific ENA antibodies. For example, Scl 70 antibodies indicate systemic sclerosis, while Sm antibodies have specificity for lupus.

5. When to use CPT code 86235

CPT code 86235 should be used when a lab analyst performs an assay to evaluate the patient’s serum for each specific ENA antibody. It is appropriate to bill this code for each antibody tested.

6. Documentation requirements

To support a claim for CPT 86235, the documentation should include:

• Reason for ordering the test, such as a positive ANA blood test
• Specific ENA antibodies tested
• Date of the test
• Results of the test, indicating positive, negative, or semiquantitative value

7. Billing guidelines

When billing for CPT 86235, ensure that the test is performed by a lab analyst and that each specific ENA antibody is evaluated. Report one unit of this code for each antibody tested. It is important to note that some payers may separately reimburse for specimen collection using a different code, such as 36415.

8. Historical information

CPT 86235 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 assay to evaluate a patient’s serum for anti RNP antibodies.
2. The lab analyst tests the patient’s serum for anti SS A and SS B antibodies using a multiplex flow immunoassay.
3. An assay is performed to detect the presence of anti Sm antibodies in the patient’s serum.
4. The lab analyst evaluates the patient’s serum for anti Scl 70 antibodies, indicating systemic sclerosis.
5. A clinician orders the test to determine the presence of anti ENA antibodies in a patient with lupus.
6. The lab analyst performs an assay to evaluate the patient’s serum for each specific ENA antibody, providing a comprehensive assessment of the patient’s autoimmune connective tissue disease.
7. An assay is performed to detect the presence of anti RNP antibodies in a patient with suspected mixed connective tissue disease.
8. The lab analyst tests the patient’s serum for anti SS A and SS B antibodies, aiding in the diagnosis of Sjogren’s syndrome.
9. An assay is performed to evaluate the patient’s serum for anti Sm antibodies, indicating the presence of lupus.
10. The lab analyst evaluates the patient’s serum for anti Scl 70 antibodies, confirming the diagnosis of systemic sclerosis.