How To Use CPT Code 86603

CPT 86603 describes the immunoassay procedure used to evaluate a patient’s specimen for antibodies to adenovirus. 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 86603?

CPT 86603 can be used to describe the immunoassay procedure performed by a lab analyst to test a patient’s serum or cerebrospinal fluid (CSF) for antibodies to adenovirus. This test involves multiple steps, such as reacting the specimen with test antigens, incubating the mixture, and detecting the antigen/antibody complex using stains, fluorescence, or other markers. The results of the test can be interpreted as positive, negative, or semi-quantitative.

2. Official Description

The official description of CPT code 86603 is: ‘Antibody; adenovirus.’

3. Procedure

1. The lab analyst collects the patient’s serum or CSF specimen.
2. The specimen is tested using an immunoassay method, such as enzyme immunoassay (EIA) or enzyme-linked immunosorbent assay (ELISA).
3. The test involves multiple steps, including reacting the specimen with test antigens, incubating the mixture, and detecting the antigen/antibody complex using stains, fluorescence, or other markers.
4. The results of the test are interpreted as positive, negative, or semi-quantitative.

4. Qualifying circumstances

CPT 86603 is used to test for antibodies to adenovirus in the patient’s serum or CSF. This test can aid in the diagnosis of respiratory conditions, eye inflammation (conjunctivitis), or other conditions caused by adenovirus infection. It is important to note that this code is specifically for antibody detection and should not be used for antigen detection.

5. When to use CPT code 86603

CPT code 86603 should be used when performing a multi-step immunoassay to detect antibodies to adenovirus in the patient’s serum or CSF. This code is not appropriate for single-step methods or quantitative tests. It is important to use the correct code based on the specific testing method used.

6. Documentation requirements

To support a claim for CPT 86603, the documentation should include:

• Indication of why the test was ordered, such as respiratory symptoms or eye inflammation
• Details of the immunoassay method used, such as EIA or ELISA
• Date of the test
• Results of the test, interpreted as positive, negative, or semi-quantitative

7. Billing guidelines

When billing for CPT 86603, it is important to follow these guidelines:

• Ensure that the test is performed by a lab analyst
• Use the appropriate code for specimen collection, such as 36415 for venipuncture or 62270 for lumbar puncture
• Report one unit of CPT 86603 for each immunoglobulin class or adenovirus serotype tested
• If multiple units of CPT 86603 are performed, consider using modifiers 91 or 59 to indicate distinct tests

8. Historical information

CPT 86603 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs an immunoassay to test a patient’s serum for antibodies to adenovirus, and the results are positive.
2. A patient with respiratory symptoms undergoes an immunoassay to detect antibodies to adenovirus in their CSF, and the results are negative.
3. An ophthalmologist orders an immunoassay to test a patient’s serum for antibodies to adenovirus due to eye inflammation, and the results are semi-quantitative.
4. A lab analyst performs an immunoassay to evaluate a patient’s CSF for antibodies to adenovirus, and the results are positive for adenovirus serotype 14.
5. A pediatrician orders an immunoassay to test a child’s serum for antibodies to adenovirus, and the results are negative.