How To Use CPT Code 86305

CPT 86305 describes the quantitative testing of a patient’s serum for human epididymis protein 4 (HE4), which is a tumor marker for ovarian 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 86305?

CPT 86305 can be used to perform a quantitative test on a patient’s serum or body fluid sample to evaluate the presence of human epididymis protein 4 (HE4). This protein serves as a tumor marker for ovarian cancer and is measured using an immunoassay method called electrochemiluminescence (ECLIA). The test involves various steps, including reacting the specimen with test antibodies, incubating the mixture, adding microparticles to bind the complexes to an electrode, and measuring the luminescence using a photomultiplier. The results are reported quantitatively as a number.

2. Official Description

The official description of CPT code 86305 is: ‘Human epididymis protein 4 (HE4); quantitative.’

3. Procedure

1. The lab analyst collects a serum or body fluid sample from the patient.
2. The analyst performs the immunoassay method, ECLIA, to test the sample for the presence of HE4.
3. The test involves reacting the specimen with test antibodies, incubating the mixture, adding microparticles to bind the complexes to an electrode, and measuring the luminescence using a photomultiplier.
4. The results are reported quantitatively as a number, indicating the level of HE4 in the patient’s sample.

4. Qualifying circumstances

CPT 86305 is typically ordered by clinicians to monitor therapy for epithelial ovarian cancer, a type of cancer that lines the surface of the ovary. It is not specific or sensitive enough to be used as a screening test for ovarian cancer in asymptomatic patients. The test may be used to follow the course of disease progression, evaluate the effectiveness of therapy, and detect possible recurrence. The presence of HE4 in the patient’s serum or body fluid indicates the presence of ovarian cancer.

5. When to use CPT code 86305

CPT code 86305 should be used when a quantitative test is performed on a patient’s serum or body fluid sample to evaluate the level of human epididymis protein 4 (HE4). This test is specifically used to monitor therapy for epithelial ovarian cancer and is not intended for screening purposes.

6. Documentation requirements

To support a claim for CPT code 86305, the following documentation is required:

• Indication for the test, such as monitoring therapy for epithelial ovarian cancer
• Details of the immunoassay method used, including ECLIA
• Date of the test
• Results reported quantitatively as a number

7. Billing guidelines

When billing for CPT code 86305, ensure that the test is performed using the immunoassay method, ECLIA, and that the results are reported quantitatively. It is important to note that some payers may separately reimburse for the collection of the specimen using a different code, such as 36415 for venous blood collection by venipuncture. It is also important to follow any specific guidelines or requirements set by the payer when submitting the claim.

8. Historical information

CPT code 86305 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs a quantitative test on a patient’s serum sample to evaluate the level of human epididymis protein 4 (HE4) for monitoring therapy for epithelial ovarian cancer.
2. A clinician orders a quantitative test on a patient’s body fluid sample to assess the presence of HE4 as part of the evaluation for possible recurrence of ovarian cancer.
3. A lab technician performs a quantitative test on a patient’s serum sample to monitor the effectiveness of therapy for epithelial ovarian cancer.
4. A physician orders a quantitative test on a patient’s body fluid sample to track the progression of epithelial ovarian cancer and evaluate the need for additional treatment.
5. A lab analyst performs a quantitative test on a patient’s serum sample to assess the level of HE4 and guide the management of therapy for epithelial ovarian cancer.
6. A clinician orders a quantitative test on a patient’s body fluid sample to monitor the response to therapy for epithelial ovarian cancer and adjust the treatment plan accordingly.
7. A lab technician performs a quantitative test on a patient’s serum sample to evaluate the level of HE4 and determine the effectiveness of therapy for epithelial ovarian cancer.
8. A physician orders a quantitative test on a patient’s body fluid sample to assess the presence of HE4 and guide the decision-making process for further treatment options in epithelial ovarian cancer.
9. A lab analyst performs a quantitative test on a patient’s serum sample to monitor the progression of epithelial ovarian cancer and evaluate the need for additional interventions.
10. A clinician orders a quantitative test on a patient’s body fluid sample to track the response to therapy for epithelial ovarian cancer and make informed decisions regarding the continuation or modification of treatment.