How To Use CPT Code 86381

CPT 86381 describes a test that detects the presence of a mitochondrial antibody, such as M2, in a specimen, typically serum. 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 86381?

CPT 86381 can be used to identify the presence of a specific mitochondrial antibody, such as M2, in a specimen, usually serum. This test is commonly performed using enzyme immunoassay (EIA) methodology. The detection of certain mitochondrial antibodies, particularly M2, aids in the diagnosis of primary biliary cholangitis (PBC), an autoimmune disease characterized by damage to the bile ducts and subsequent liver damage.

2. Official Description

The official description of CPT code 86381 is: ‘Mitochondrial antibody (eg, M2), each.’

3. Procedure

1. The lab analyst performs an enzyme immunoassay (EIA) test to detect the presence of a specific mitochondrial antibody, such as M2, in a serum specimen.
2. The test involves mixing the patient’s serum with M2 antigens and adding a reagent attached to an enzyme.
3. If the M2 antibody is present in the specimen, a color reaction occurs, which can be measured using a spectrophotometer.

4. Qualifying circumstances

CPT 86381 is typically ordered by clinicians to aid in the diagnosis of primary biliary cholangitis (PBC), an autoimmune disease caused by M2 antibodies attacking the body’s bile ducts. This condition leads to the accumulation of bile in the liver, resulting in liver damage and potential failure. The test is not limited to PBC diagnosis and may be used to detect the presence of other mitochondrial antibodies.

5. When to use CPT code 86381

CPT code 86381 should be used when performing a test to detect a specific mitochondrial antibody, such as M2, in a specimen. It is important to use this specific code rather than less-specific codes, such as 86255 or 83516, to accurately reflect the nature of the test being performed.

6. Documentation requirements

To support a claim for CPT 86381, documentation should include:

• Indication of the need for the test, such as suspicion of primary biliary cholangitis or other conditions associated with mitochondrial antibodies
• Details of the specific mitochondrial antibody being tested, such as M2
• Methodology used, such as enzyme immunoassay (EIA)
• Date of the test
• Results of the test, including any relevant measurements or interpretations
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86381, ensure that the test is performed to detect a mitochondrial antibody, such as M2, in a specimen. It is important to use this specific code rather than less-specific codes. Some payers may also provide separate reimbursement for specimen collection.

8. Historical information

CPT 86381 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 patient with suspected primary biliary cholangitis undergoes a test to detect the presence of M2 antibodies in their serum specimen using CPT 86381.
2. A clinician orders a mitochondrial antibody test, including M2, to aid in the diagnosis of a patient with liver dysfunction.
3. A patient with symptoms suggestive of an autoimmune disorder undergoes a test to detect the presence of mitochondrial antibodies, including M2, using CPT 86381.
4. A patient with a family history of primary biliary cholangitis undergoes a screening test for M2 antibodies using CPT 86381.
5. A patient with unexplained liver enzyme abnormalities undergoes a test to detect the presence of mitochondrial antibodies, including M2, using CPT 86381.
6. A clinician orders a mitochondrial antibody test, including M2, to monitor the progression of primary biliary cholangitis in a patient.
7. A patient with suspected autoimmune liver disease undergoes a test to detect the presence of mitochondrial antibodies, including M2, using CPT 86381.
8. A patient with symptoms suggestive of primary biliary cholangitis undergoes a test to confirm the presence of M2 antibodies using CPT 86381.
9. A clinician orders a mitochondrial antibody test, including M2, to evaluate a patient with suspected liver involvement in an autoimmune disorder.
10. A patient with a known diagnosis of primary biliary cholangitis undergoes a test to monitor the levels of M2 antibodies using CPT 86381.