How To Use CPT Code 86618

CPT 86618 describes the immunoassay procedure used to evaluate a patient’s blood or cerebrospinal fluid for antibodies to the bacterium Borrelia burgdorferi, which causes Lyme disease. 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 86618?

CPT 86618 is a code used to describe the immunoassay procedure performed by a lab analyst to test a patient’s blood or cerebrospinal fluid for antibodies to the bacterium Borrelia burgdorferi. This test is often ordered as an initial screening for the diagnosis of Lyme disease or to help identify neurologic Lyme disease. The procedure involves various steps, including reacting the specimen with test antigens, incubating the mixture, and interpreting the results as positive, negative, or semi-quantitative.

2. Official Description

The official description of CPT code 86618 is: ‘Antibody; Borrelia burgdorferi (Lyme disease).’ This code is used to report the immunoassay procedure performed to detect antibodies to Borrelia burgdorferi in the patient’s blood or cerebrospinal fluid.

3. Procedure

1. The lab analyst collects a blood or cerebrospinal fluid specimen from the patient using venipuncture or lumbar puncture.
2. The collected specimen is then subjected to an immunoassay procedure, such as enzyme-linked immunosorbent assay (ELISA), to detect antibodies specific to Borrelia burgdorferi.
3. The procedure involves reacting the specimen with test antigens, incubating the mixture, and adding an agent to detect the antigen/antibody complex.
4. The lab analyst interprets the results of the immunoassay as positive, negative, or semi-quantitative.

4. Qualifying circumstances

CPT 86618 is used when a patient’s blood or cerebrospinal fluid is tested for antibodies to Borrelia burgdorferi. This test is commonly ordered as an initial screening for Lyme disease or to help identify neurologic Lyme disease. It is important to note that this code should only be used for the detection of antibodies and not for antigen detection.

5. When to use CPT code 86618

CPT code 86618 should be used when performing a multi-step qualitative or semi-quantitative immunoassay to detect antibodies specific to Borrelia burgdorferi in a patient’s blood or cerebrospinal fluid. 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 code 86618, the following documentation is required:

• Indication of the need for the test, such as suspicion of Lyme disease or neurologic Lyme disease
• Details of the immunoassay procedure performed, including the specific method used (e.g., ELISA)
• Date of the test and the results interpreted as positive, negative, or semi-quantitative
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT code 86618, it is important to ensure that the immunoassay procedure was performed to detect antibodies to Borrelia burgdorferi. This code should not be reported for antigen detection. If multiple units of this code are performed, modifiers such as 91 or 59 may be necessary to indicate that the tests are distinct. Additionally, check with the payer regarding separate reimbursement for specimen collection using appropriate codes such as 36415 for venipuncture or 62270 for lumbar puncture.

8. Historical information

CPT code 86618 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs an immunoassay to detect antibodies to Borrelia burgdorferi in a patient’s blood, indicating a positive result for Lyme disease.
2. A patient with suspected neurologic Lyme disease undergoes an immunoassay procedure on their cerebrospinal fluid, which shows negative results for antibodies to Borrelia burgdorferi.
3. A multi-step immunoassay is performed on a blood specimen, and the results indicate a semi-quantitative value for antibodies to Borrelia burgdorferi in a patient with symptoms suggestive of Lyme disease.
4. A lab analyst interprets the immunoassay results as negative for antibodies to Borrelia burgdorferi in a patient who had a tick bite but no symptoms of Lyme disease.
5. An immunoassay is performed on a cerebrospinal fluid specimen, and the results show positive antibodies to Borrelia burgdorferi, confirming the diagnosis of neurologic Lyme disease in a patient with neurological symptoms.