How To Use CPT Code 86651

CPT 86651 describes the immunoassay procedure used to evaluate a patient’s serum or cerebrospinal fluid for antibodies to the California virus, also known as the La Crosse virus, which causes encephalitis. 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 86651?

CPT 86651 is used to describe the immunoassay procedure performed by a lab analyst to test a patient’s serum or cerebrospinal fluid for antibodies to the California virus, also known as the La Crosse virus. This virus is an arborvirus, or insect-borne virus, that can cause encephalitis, an inflammation of the brain. The immunoassay procedure may involve steps such as reacting the specimen with test antigens, incubating the mixture, adding an agent to detect the antigen/antibody complex, and interpreting the results.

2. Official Description

The official description of CPT code 86651 is: ‘Antibody; encephalitis, California (La Crosse).’ This code represents the immunoassay procedure used to detect antibodies to the California virus in a patient’s serum or cerebrospinal fluid.

3. Procedure

1. The lab analyst collects a specimen of the patient’s serum or cerebrospinal fluid.
2. The lab analyst performs an immunoassay procedure, such as an indirect immunofluorescence assay (IFA) or enzyme-linked immunosorbent assay (ELISA), to test the specimen for antibodies to the California virus.
3. The immunoassay procedure may involve steps such as reacting the specimen with test antigens, incubating the mixture, adding an agent to detect the antigen/antibody complex, and interpreting the results as positive, negative, or semi-quantitative.
4. The lab analyst records the results of the immunoassay procedure.

4. Qualifying circumstances

CPT 86651 is used when a patient’s serum or cerebrospinal fluid is tested for antibodies to the California virus, specifically for the diagnosis of California virus encephalitis. This test may be ordered by clinicians to aid in the diagnosis of encephalitis, which is characterized by symptoms such as stiff neck, lethargy, and seizures. The presence of antibodies to the California virus in the serum or cerebrospinal fluid can help confirm exposure to the virus or diagnose neurological infection.

5. When to use CPT code 86651

CPT code 86651 should be used when performing a multi-step qualitative or semi-quantitative immunoassay to detect antibodies to the California virus. This code should not be used for antigen detection or for single-step methods such as reagent strips. For quantitative tests, a different code should be used. It is important to use this code only when testing for antibodies to the California virus and not for other purposes.

6. Documentation requirements

To support a claim for CPT code 86651, the documentation should include:

• Indication of the need for the test, such as suspected California virus encephalitis
• Details of the immunoassay procedure performed, including the specific method used (e.g., IFA or ELISA)
• Date of the test
• Results of the test, including whether the antibodies were detected or not
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT code 86651, it is important to ensure that the immunoassay procedure was performed to detect antibodies to the California virus. This code should not be reported for antigen detection or single-step methods. If multiple units of this code are performed, modifiers may be necessary to indicate that the tests are distinct. It is also important to check with the payer regarding separate payment for specimen collection using appropriate codes.

8. Historical information

CPT code 86651 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 procedure to test a patient’s serum for antibodies to the California virus, indicating exposure to the virus.
2. A patient with symptoms of encephalitis undergoes an immunoassay procedure to test their cerebrospinal fluid for antibodies to the California virus, confirming a neurological infection.
3. A clinician orders an immunoassay procedure to test a patient’s serum for antibodies to the California virus, aiding in the diagnosis of California virus encephalitis.
4. A lab analyst performs an immunoassay procedure to test a patient’s cerebrospinal fluid for antibodies to the California virus, ruling out the presence of the virus in the central nervous system.
5. A patient with suspected exposure to the California virus undergoes an immunoassay procedure to test their serum for antibodies, confirming the presence of the virus.
6. A lab analyst performs an immunoassay procedure to test a patient’s cerebrospinal fluid for antibodies to the California virus, providing evidence of a neurological infection.
7. A clinician orders an immunoassay procedure to test a patient’s serum for antibodies to the California virus, aiding in the diagnosis of encephalitis.
8. A lab analyst performs an immunoassay procedure to test a patient’s cerebrospinal fluid for antibodies to the California virus, confirming the presence of the virus in the central nervous system.
9. A patient with suspected California virus encephalitis undergoes an immunoassay procedure to test their serum for antibodies, ruling out exposure to the virus.