How To Use CPT Code 86301

CPT 86301 describes the immunoassay for tumor antigen CA 19-9, which is used to evaluate the patient’s serum or body fluid for pancreatic cancer. 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 86301?

CPT 86301 can be used to perform a quantitative immunoassay test on a patient’s serum or body fluid to evaluate the presence of the tumor antigen CA 19-9. This test is commonly used to distinguish pancreatic cancer from pancreatitis or bile duct obstruction. It can also be used for serial monitoring of CA 19-9 levels to track disease progression and detect possible recurrence. However, it is important to note that CA 19-9 testing is not specific or sensitive enough for use as a screening test in asymptomatic patients.

2. Official Description

The official description of CPT code 86301 is: ‘Immunoassay for tumor antigen, quantitative; CA 19-9.’

3. Procedure

1. The lab analyst collects a serum or body fluid sample from the patient.
2. The sample is then subjected to an immunoassay method, such as electrochemiluminescence (ECLIA), to detect the presence of CA 19-9.
3. The immunoassay involves various steps, including reacting the specimen with test antibodies, incubating the mixture, adding microparticles to bind the complexes to an electrode, and applying an electric charge to initiate luminescence.
4. A photomultiplier measures the luminescence, and the results are reported quantitatively as a number.

4. Qualifying circumstances

CPT 86301 is typically ordered by clinicians to help distinguish pancreatic cancer from other conditions such as pancreatitis or bile duct obstruction. It may also be used for serial monitoring of CA 19-9 levels to track disease progression and detect possible recurrence. The test can be performed on various body fluids, including spinal fluid, pericardial fluid, or pleural fluid, to evaluate malignancy in those areas.

5. When to use CPT code 86301

CPT code 86301 should be used when a quantitative immunoassay test is performed to evaluate the patient’s serum or body fluid for the tumor antigen CA 19-9. It is appropriate to use this code when the test is ordered to distinguish pancreatic cancer from other conditions or for serial monitoring of CA 19-9 levels. However, it should not be used as a screening test in asymptomatic patients.

6. Documentation requirements

To support a claim for CPT code 86301, the following documentation is required:

• Patient’s diagnosis or reason for ordering the test
• Details of the immunoassay method used, such as electrochemiluminescence (ECLIA)
• Date of the test
• Results reported quantitatively as a number

7. Billing guidelines

When billing for CPT code 86301, it is important to ensure that the test is performed using an immunoassay method, such as electrochemiluminescence (ECLIA), and that the results are reported quantitatively. Some payers may also require separate billing for specimen collection using a code such as 36415. It is important to review payer-specific guidelines for accurate billing.

8. Historical information

CPT code 86301 was added to the Current Procedural Terminology system on January 1, 2001. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with symptoms suggestive of pancreatic cancer undergoes a quantitative immunoassay test for CA 19-9, and the results are reported as a number.
2. A patient with a history of pancreatic cancer undergoes serial monitoring of CA 19-9 levels using a quantitative immunoassay test.
3. A patient presents with symptoms of bile duct obstruction, and a quantitative immunoassay test for CA 19-9 is performed to help differentiate between pancreatic cancer and other conditions.
4. A patient with pleural fluid accumulation undergoes a quantitative immunoassay test for CA 19-9 to evaluate the presence of malignancy in the pleural area.
5. A patient with pericardial fluid accumulation undergoes a quantitative immunoassay test for CA 19-9 to evaluate the presence of malignancy in the pericardial area.