How To Use CPT Code 86403

CPT 86403 describes the procedure for particle agglutination, specifically a screen for each antibody. 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 86403?

CPT 86403 can be used to describe the procedure for particle agglutination, specifically a screen for each antibody. This code is used when a lab analyst performs a screening test on a patient specimen, typically a blood specimen, to evaluate the patient’s immune status or check for various illnesses.

2. Official Description

The official description of CPT code 86403 is: ‘Particle agglutination; screen, each antibody.’

3. Procedure

1. The provider discusses the need for blood testing with the patient or guardian.
2. The lab analyst performs the technical steps to test the patient’s blood, identifying and assaying concentrations of a specific antigen.
3. A mixture is prepared that contains a limited amount of a substance which binds univalently with a proportion of the antigen present.
4. The patient specimen, such as serum, is mixed with the specific antigen reagent, causing the specific antibody present in the specimen to form an antibody/antigen compound that results in clumps falling out of the solution.
5. Unusually large concentrations of antigen that bind to the univalent substance can be assayed, while a smaller amount of antigen may still remain free in the solution.
6. The provider discusses the result with the patient or guardian and addresses the next steps to treatment.

4. Qualifying circumstances

Patients eligible to receive CPT 86403 services are those who require a screening test for each antibody to evaluate their immune status or check for specific illnesses. The procedure is performed by a lab analyst on a patient specimen, typically a blood specimen.

5. When to use CPT code 86403

CPT code 86403 should be used when a lab analyst performs a particle agglutination screen for each antibody on a patient specimen. It is important to note that this code is subject to Clinical Laboratory Improvement Amendments (CLIA) edits.

6. Documentation requirements

To support a claim for CPT 86403, the provider must document the following information:

• Discussion of the need for blood testing with the patient or guardian
• Specific details of the particle agglutination procedure performed
• Result of the screening test for each antibody
• Discussion of the result with the patient or guardian
• Next steps to treatment

7. Billing guidelines

When billing for CPT 86403, ensure that the procedure is performed by a lab analyst on a patient specimen, typically a blood specimen. It is important to report CPT 86403 for each separate antibody screen. Additionally, report CPT 86403 in conjunction with a venipuncture or blood draw code, as specimen collections are coded separately.

8. Historical information

CPT 86403 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a particle agglutination screen for each antibody on a patient specimen to evaluate the patient’s immune status.
2. A screening test for each antibody is performed on a blood specimen to check for specific illnesses.
3. A patient undergoes a particle agglutination procedure to assess their immune response to various antigens.
4. A lab analyst performs a screen for each antibody on a patient specimen to identify and assay concentrations of a specific antigen.
5. A particle agglutination test is conducted on a blood specimen to determine the presence of specific antibodies.
6. A screening procedure is performed to evaluate the patient’s immune status by testing for each antibody in their blood specimen.
7. A lab analyst performs a particle agglutination screen for each antibody to check for the presence of specific antigens in a patient’s blood specimen.
8. A patient undergoes a screening test for each antibody to assess their immune response to various pathogens.
9. A particle agglutination procedure is performed to identify and assay concentrations of specific antigens in a patient’s blood specimen.
10. A lab analyst performs a screen for each antibody on a patient specimen to evaluate the patient’s immune status and detect any abnormalities.