How To Use CPT Code 86361

CPT 86361 describes the measurement of T cells, specifically the absolute CD4 count, in a patient’s blood. 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 86361?

CPT 86361 can be used to measure the absolute CD4 count, which refers to the number of CD4 cells in each micro liter of a patient’s blood. This test is typically ordered by a healthcare provider to assess the strength of the patient’s immune system, especially after a diagnosis of HIV infection.

2. Official Description

The official description of CPT code 86361 is: ‘T cells; absolute CD4 count.’

3. Procedure

1. The lab analyst performs a flow cytometry test on the patient’s blood sample to identify and count the CD4 cells.
2. The test may involve separating the cells and using a FACS scan or a FACS Count Cyflow SL® instrument to identify the CD4 cells.
3. A normal CD4 count in blood ranges from 600 to 1200 cells per cubic millimeter.
4. A CD4 count below 200 indicates a higher risk of infection.
5. The lab analyst quantifies the findings and interprets the results as normal, more than normal, or less than normal.

4. Qualifying circumstances

CPT 86361 is typically ordered by healthcare providers to assess the strength of a patient’s immune system, particularly after a diagnosis of HIV infection. The test measures the absolute CD4 count, which refers to the number of CD4 cells in each micro liter of blood. CD4 cells are a type of white blood cell that helps fight infection. A lower CD4 count indicates a higher risk of infection.

5. When to use CPT code 86361

CPT code 86361 should be used when a healthcare provider orders a test to measure the absolute CD4 count in a patient’s blood. This test is particularly relevant for patients diagnosed with HIV infection, as the virus destroys CD4 cells and lowers the CD4 count. The lower the CD4 count, the greater the risk of infection.

6. Documentation requirements

To support a claim for CPT 86361, the healthcare provider must document the following information:

• Reason for ordering the test, such as a diagnosis of HIV infection
• Details of the test performed, including the use of flow cytometry and any specific instruments used
• Results of the absolute CD4 count, indicating whether it is within the normal range or not
• Interpretation of the results, comparing them to the normal range and assessing the patient’s risk of infection
• Signature of the healthcare provider ordering the test

7. Billing guidelines

When billing for CPT 86361, ensure that the test is performed to measure the absolute CD4 count in a patient’s blood. There are no specific guidelines regarding reporting this code with other codes. However, it is important to accurately document the medical necessity of the test and provide appropriate supporting documentation.

8. Historical information

CPT 86361 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider orders a CD4 count test for a patient recently diagnosed with HIV infection to assess the strength of their immune system.
2. A lab analyst performs a flow cytometry test on a blood sample to measure the absolute CD4 count of a patient with a history of immune system disorders.
3. A healthcare provider orders a CD4 count test for a patient undergoing chemotherapy to monitor the impact of the treatment on their immune system.
4. A lab analyst quantifies the CD4 count of a patient and interprets the results as lower than normal, indicating a higher risk of infection.
5. A healthcare provider reviews the CD4 count results and adjusts the patient’s treatment plan accordingly to support their immune system.
6. A lab analyst performs a flow cytometry test on a blood sample to measure the absolute CD4 count of a patient with suspected immunodeficiency.
7. A healthcare provider orders a CD4 count test for a patient with a history of recurrent infections to assess the strength of their immune system.
8. A lab analyst performs a flow cytometry test on a blood sample to measure the absolute CD4 count of a patient before and after a bone marrow transplant.
9. A healthcare provider reviews the CD4 count results and recommends additional preventive measures to reduce the patient’s risk of infection.
10. A lab analyst quantifies the CD4 count of a patient and interprets the results as within the normal range, indicating a healthy immune system.