How To Use CPT Code 86406

CPT 86406 describes the procedure for performing a titer test to determine the concentration of a specific antibody in a patient’s specimen following a positive particle agglutination screening test. 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 86406?

CPT 86406 can be used to describe the procedure for performing a titer test to evaluate the concentration of a specific antibody in a patient’s specimen. This test is typically performed following a positive particle agglutination screening test, and it provides a quantitative measure of the antibody’s concentration.

2. Official Description

The official description of CPT code 86406 is: ‘Particle agglutination; titer, each antibody.’

3. Procedure

1. The lab analyst performs a titer test to determine the concentration of a specific antibody present in the patient’s specimen.
2. The titer test involves a series of dilutions or agglutination reactions with varying levels of reagent antigen.
3. The analyst evaluates the quantitative level of the specific antibody by assessing the highest dilution or level of test analyte that gives a positive result.
4. One unit of CPT 86406 represents performing a titer for one antibody.

4. Qualifying circumstances

CPT 86406 is typically ordered by clinicians to evaluate the immune status or check for specific illnesses caused by infecting organisms. It is commonly performed as a reflex test following a positive particle agglutination screening test. The test is not limited to a specific condition and can be used to assess the concentration of various antibodies in a patient’s specimen.

5. When to use CPT code 86406

CPT code 86406 should be used when performing a titer test to evaluate the concentration of a specific antibody in a patient’s specimen. It is appropriate to report this code when the test is performed following a positive particle agglutination screening test and provides a quantitative measure of the antibody’s concentration.

6. Documentation requirements

To support a claim for CPT 86406, the documentation should include:

• The indication for performing the titer test
• The specific antibody being evaluated
• The date and time of the test
• The results of the test, including the concentration of the antibody
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86406, ensure that the test is performed following a positive particle agglutination screening test and provides a quantitative measure of the antibody’s concentration. It is important to report this code accurately and not confuse it with the particle agglutination screening test (CPT 86403). Some payers may also separately reimburse for specimen collection using a code such as 36415 for venipuncture.

8. Historical information

CPT 86406 was added to the Current Procedural Terminology system on January 1, 1995. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs a titer test to evaluate the concentration of anti-HIV antibodies in a patient’s specimen following a positive particle agglutination screening test.
2. Following a positive particle agglutination screening test for Lyme disease, a titer test is performed to assess the concentration of anti-Borrelia burgdorferi antibodies in the patient’s specimen.
3. After a positive particle agglutination screening test for hepatitis B, a titer test is conducted to determine the concentration of anti-HBs antibodies in the patient’s specimen.
4. Following a positive particle agglutination screening test for syphilis, a titer test is performed to evaluate the concentration of anti-Treponema pallidum antibodies in the patient’s specimen.
5. A titer test is conducted to assess the concentration of anti-streptolysin O antibodies in a patient’s specimen following a positive particle agglutination screening test for streptococcal infection.
6. After a positive particle agglutination screening test for rheumatoid arthritis, a titer test is performed to determine the concentration of anti-cyclic citrullinated peptide antibodies in the patient’s specimen.
7. Following a positive particle agglutination screening test for cytomegalovirus, a titer test is conducted to evaluate the concentration of anti-CMV antibodies in the patient’s specimen.
8. A titer test is performed to assess the concentration of anti-Helicobacter pylori antibodies in a patient’s specimen following a positive particle agglutination screening test for H. pylori infection.
9. After a positive particle agglutination screening test for rubella, a titer test is conducted to determine the concentration of anti-rubella antibodies in the patient’s specimen.
10. Following a positive particle agglutination screening test for varicella-zoster virus, a titer test is performed to evaluate the concentration of anti-varicella-zoster antibodies in the patient’s specimen.