How To Use CPT Code 86363

CPT 86363 describes a specific test that is used to identify an antibody called myelin oligodendrocyte glycoprotein (MOG-IgG1) in a patient’s serum specimen. 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 86363?

CPT 86363 is a code that represents a laboratory test used to detect the presence of an antibody called myelin oligodendrocyte glycoprotein (MOG-IgG1) in a patient’s serum specimen. This test utilizes a method called fluorescence-activated cell sorting (FACS) using flow cytometry. It is typically ordered by clinicians to help distinguish between neuromyelitis optica (NMO) and a similar condition known as MOG-encephalomyelitis (MOG-EM) when a previous aquaporin-4 antibody test has yielded negative results.

2. Official Description

The official description of CPT code 86363 is: ‘Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (i.e., fluorescence-activated cell sorting [FACS]), each.’

3. Procedure

1. The lab analyst performs a technical lab procedure to detect the MOG-IgG1 antibody in the patient’s serum specimen using fluorescence-activated cell sorting (FACS) with flow cytometry.
2. The test involves incubating a human-tissue cell-culture line with MOG antigens, fluorescent stain, and the patient’s specimen.
3. The specimen is then analyzed using flow cytometry, which uses a photodetector to identify fluorescently stained cells suspended in a fluid column.
4. The test identifies the presence of MOG-IgG1, an immunoglobulin (antibody) class, in the patient’s serum specimen.

4. Qualifying circumstances

CPT 86363 is used when clinicians suspect the presence of MOG-IgG1 in a patient’s serum specimen. This test is typically ordered following a negative aquaporin-4 antibody test to help differentiate between neuromyelitis optica (NMO) and MOG-encephalomyelitis (MOG-EM). It is important to note that the distinction between MOG-EM and NMO is still being studied, and it is uncertain whether MOG-EM is a distinct condition or part of the neuromyelitis optica spectrum disorder (NMOSD).

5. When to use CPT code 86363

CPT code 86363 should be used when a clinician orders a test to detect the presence of MOG-IgG1 in a patient’s serum specimen. It is specifically used when differentiating between neuromyelitis optica (NMO) and MOG-encephalomyelitis (MOG-EM) following a negative aquaporin-4 antibody test. This code should not be used for other purposes or in the absence of clinical indications.

6. Documentation requirements

To support a claim for CPT code 86363, the following documentation is required:

• Indication for the test, such as suspicion of MOG-EM or differentiation from NMO
• Details of the laboratory procedure performed, including the use of fluorescence-activated cell sorting (FACS) with flow cytometry
• Date of the test
• Results of the test, indicating the presence or absence of MOG-IgG1
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 86363, ensure that the test is performed using fluorescence-activated cell sorting (FACS) with flow cytometry to detect the MOG-IgG1 antibody. It is important to select the correct code, as there are other codes available for MOG-IgG1 detection (e.g., CPT codes 86362). It is also important to follow any specific guidelines provided by payers regarding billing for this test.

8. Historical information

CPT code 86363 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 clinician orders CPT code 86363 to detect the presence of MOG-IgG1 in a patient’s serum specimen following a negative aquaporin-4 antibody test.
2. After suspecting MOG-EM in a patient, a clinician requests CPT code 86363 to differentiate it from neuromyelitis optica (NMO).
3. CPT code 86363 is used by a clinician to confirm the presence of MOG-IgG1 in a patient’s serum specimen, supporting the diagnosis of MOG-EM.
4. Following a negative aquaporin-4 antibody test, a clinician orders CPT code 86363 to investigate the possibility of MOG-EM in a patient.
5. A clinician utilizes CPT code 86363 to detect the presence of MOG-IgG1 in a patient’s serum specimen, aiding in the differentiation between NMO and MOG-EM.
6. When suspecting MOG-EM in a patient, a clinician orders CPT code 86363 to confirm the presence of MOG-IgG1 in their serum specimen.
7. CPT code 86363 is used by a clinician to identify the presence of MOG-IgG1 in a patient’s serum specimen, supporting the diagnosis of MOG-EM.