How To Use CPT Code 86409
CPT 86409 describes the analysis of neutralizing antibodies in a specimen, specifically for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). 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 86409?
CPT 86409 can be used to analyze the titer (concentration) of neutralizing antibodies in a specimen, such as plasma, to determine the level of immunity to re-infection with SARS-CoV-2, the virus that causes COVID-19. This code is used when a lab analyst performs the technical steps to analyze the specimen using a titer dilution method.
2. Official Description
The official description of CPT code 86409 is: ‘Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]); titer.’
3. Procedure
- The lab analyst performs the technical steps to analyze a specimen, such as plasma, for the presence of neutralizing antibodies against SARS-CoV-2.
- A titer dilution method is used to determine the concentration of neutralizing antibodies in the specimen.
- Methods such as pseudotyped-lentiviral-vector-based neutralization assay, plaque reduction neutralization test (PRNT), and ELISA may be used to analyze the neutralizing antibody titer.
4. Qualifying circumstances
CPT 86409 is used when analyzing the titer of neutralizing antibodies in a specimen, specifically for SARS-CoV-2. This test is performed to determine the level of immunity to re-infection with the virus. It is typically ordered for individuals who have had a past infection with COVID-19 and may be considered for convalescent plasma therapy or vaccine development.
5. When to use CPT code 86409
CPT code 86409 should be used when analyzing the titer of neutralizing antibodies in a specimen, specifically for SARS-CoV-2. It is appropriate to bill this code when performing the test to determine the level of immunity to re-infection with the virus. This code should not be used for other purposes or for analyzing antibodies against different viruses or diseases.
6. Documentation requirements
To support a claim for CPT 86409, the documentation should include:
- Indication for performing the test, such as past infection with COVID-19
- Details of the specimen analyzed, such as plasma
- Method used to analyze the neutralizing antibody titer
- Results of the titer analysis
- Signature of the lab analyst performing the test
7. Billing guidelines
When billing for CPT 86409, ensure that the test is performed to analyze the titer of neutralizing antibodies specific to SARS-CoV-2. This code should not be reported with other codes unless necessary for additional services provided. It is important to follow payer-specific guidelines and policies for proper reimbursement. Consider using modifier 26 for professional component billing and modifier TC for technical component billing, if applicable.
8. Historical information
CPT 86409 was added to the Current Procedural Terminology system on August 10, 2020. There have been no updates to the code since its addition.
9. Examples
- A lab analyst performing the titer analysis of neutralizing antibodies in a plasma specimen from an individual who had a past infection with COVID-19.
- An analysis of the neutralizing antibody titer in a specimen to determine the level of immunity to re-infection with SARS-CoV-2.
- Performing the titer analysis of neutralizing antibodies in plasma for convalescent plasma therapy.
- Analyzing the neutralizing antibody titer in a specimen as part of vaccine development for COVID-19.
- Performing the titer analysis of neutralizing antibodies in a plasma specimen to assess the effectiveness of a vaccine against SARS-CoV-2.
- Analyzing the neutralizing antibody titer in a specimen to study the immune response to COVID-19.
- Performing the titer analysis of neutralizing antibodies in plasma for research purposes related to SARS-CoV-2.
- Analyzing the neutralizing antibody titer in a specimen to determine the prevalence of immunity to COVID-19 in a population.
- Performing the titer analysis of neutralizing antibodies in plasma to assess the duration of immunity after a COVID-19 infection.
- Analyzing the neutralizing antibody titer in a specimen to compare the immune response in different age groups affected by COVID-19.
