How To Use CPT Code 86596

CPT 86596 describes a test that identifies the presence of an antibody to voltage-gated calcium channel (VGCC) in a specimen, such as 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 86596?

CPT 86596 can be used to identify the presence of an antibody to voltage-gated calcium channel (VGCC) in a specimen, typically serum. This test is often performed using a radioimmunoassay (RIA) method, which involves incubating the patient’s specimen with a radioactively labeled antigen for the desired antibody target. The level of the targeted antibody, such as VGCC P/G type or VGCC N-type, can then be quantified by measuring emitted radiation.

2. Official Description

The official description of CPT code 86596 is: ‘Voltage-gated calcium channel antibody, each.’

3. Procedure

1. The lab analyst performs a test, such as a radioimmunoassay (RIA), to detect the presence of an antibody to voltage-gated calcium channel (VGCC) in a specimen, typically serum.
2. The patient’s specimen is incubated with a radioactively labeled antigen for the desired antibody target, such as VGCC P/G type or VGCC N-type.
3. After rinsing away unconjugated radio label, the analyst uses a counter for emitted radiation to quantify the level of the targeted antibody present in the specimen.

4. Qualifying circumstances

CPT 86596 is typically ordered by clinicians to aid in the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS), an autoimmune disorder characterized by muscle weakness. The presence of certain VGCC antibodies, especially P/G type and possibly N-type, can help in the diagnosis of LEMS. LEMS is often associated with small cell lung cancer (SCLC), particularly in older male patients.

5. When to use CPT code 86596

CPT code 86596 should be used when there is a need to identify the presence of an antibody to voltage-gated calcium channel (VGCC) in a specimen, such as serum. It is particularly useful in aiding the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) and its association with small cell lung cancer (SCLC).

6. Documentation requirements

To support a claim for CPT 86596, the following documentation is required:

• Indication for the test, such as suspicion of Lambert-Eaton myasthenic syndrome (LEMS)
• Type of specimen tested, such as serum
• Method used for the test, such as radioimmunoassay (RIA)
• Results of the test, including the presence or absence of VGCC antibodies
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86596, ensure that the test is performed to identify an antibody to voltage-gated calcium channel (VGCC) in a specimen. It is important to use this specific code (86596) rather than a less-specific code, such as 83519. Some payers may also separately reimburse for specimen collection.

8. Historical information

CPT 86596 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Examples

1. A patient with muscle weakness is suspected to have Lambert-Eaton myasthenic syndrome (LEMS). CPT code 86596 is used to identify the presence of VGCC antibodies in their serum specimen.
2. A clinician orders CPT code 86596 to aid in the diagnosis of LEMS in a patient with small cell lung cancer (SCLC).
3. A lab analyst performs a radioimmunoassay (RIA) using CPT code 86596 to detect VGCC antibodies in a patient’s serum specimen.
4. CPT code 86596 is used to identify the presence of VGCC antibodies in a serum specimen of a patient with muscle weakness and suspected LEMS.
5. A patient with muscle weakness and a history of small cell lung cancer (SCLC) undergoes testing with CPT code 86596 to aid in the diagnosis of LEMS.
6. A lab technician performs a radioimmunoassay (RIA) using CPT code 86596 to detect VGCC antibodies in a patient’s serum specimen.
7. CPT code 86596 is used to identify the presence of VGCC antibodies in the serum specimen of a patient with muscle weakness and suspected LEMS.
8. A clinician orders CPT code 86596 to aid in the diagnosis of LEMS in a patient with a history of small cell lung cancer (SCLC).
9. A lab analyst performs a radioimmunoassay (RIA) using CPT code 86596 to detect VGCC antibodies in a patient’s serum specimen.
10. CPT code 86596 is used to identify the presence of VGCC antibodies in a serum specimen of a patient with muscle weakness and suspected LEMS.