How To Use CPT Code 86654

CPT 86654 describes the immunoassay procedure used to evaluate a patient’s serum or cerebrospinal fluid for antibodies to the Western equine encephalitis virus (WEE). 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 86654?

CPT 86654 can be used to describe the immunoassay procedure performed by a lab analyst to test a patient’s serum or cerebrospinal fluid for antibodies to the Western equine encephalitis virus (WEE). This code represents a multi-step qualitative or semi-quantitative immunoassay, such as an indirect immunofluorescence assay (IFA) or enzyme-linked immunosorbent assay (ELISA), to detect the presence of WEE antibodies in the patient’s specimen.

2. Official Description

The official description of CPT code 86654 is: ‘Antibody; encephalitis, Western equine.’

3. Procedure

1. The lab analyst collects a specimen of the patient’s serum or cerebrospinal fluid.
2. The lab analyst performs a multi-step immunoassay procedure, such as an IFA or ELISA, to detect antibodies to the Western equine encephalitis virus.
3. The procedure may involve 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 and reports them to the clinician.

4. Qualifying circumstances

CPT 86654 is typically ordered by clinicians to aid in the diagnosis of Western equine encephalitis (WEE) encephalitis. This mosquito-borne disease can cause symptoms such as fever, headache, and vomiting, and may lead to complications, especially in children. The test is used to detect the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to WEE in the patient’s serum or cerebrospinal fluid. Each unit of CPT 86654 represents one test for a single immunoglobulin class.

5. When to use CPT code 86654

CPT code 86654 should be used when a clinician orders a multi-step immunoassay procedure to detect antibodies to the Western equine encephalitis virus in a patient’s serum or cerebrospinal fluid. This code is not appropriate for antigen detection or for single-step methods such as reagent strips. For quantitative tests, a different code should be used.

6. Documentation requirements

To support a claim for CPT 86654, the clinician should ensure that the following documentation is included:

• Indication for ordering the test, such as suspected Western equine encephalitis
• Type of immunoassay performed, such as IFA or ELISA
• Date of the test
• Results of the test, including whether the antibodies were detected and any semi-quantitative values
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86654, it is important to follow the appropriate guidelines. Some payers may separately reimburse for specimen collection using specific codes, such as 36415 for venipuncture or 62270 for lumbar puncture. Modifier use may be necessary if multiple units of CPT 86654 are performed. It is important to check with the payer for specific requirements and guidelines.

8. Historical information

CPT 86654 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 evaluate a patient’s serum for antibodies to the Western equine encephalitis virus.
2. A clinician orders a test to detect immunoglobulin M antibodies to Western equine encephalitis in a patient’s cerebrospinal fluid.
3. A lab analyst performs an immunoassay to detect immunoglobulin G antibodies to Western equine encephalitis in a patient’s serum.
4. A patient presents with symptoms of fever and headache, and a clinician orders a test to detect antibodies to Western equine encephalitis.
5. A lab analyst performs an immunoassay to detect antibodies to Western equine encephalitis in a patient’s cerebrospinal fluid, confirming a diagnosis of encephalitis.
6. A clinician suspects Western equine encephalitis in a patient and orders a test to detect antibodies to the virus in the patient’s serum.
7. A lab analyst performs an immunoassay to detect immunoglobulin M antibodies to Western equine encephalitis in a patient’s cerebrospinal fluid, aiding in the diagnosis of encephalitis.
8. A patient with symptoms of vomiting and headache undergoes a test to detect antibodies to Western equine encephalitis in their serum.
9. A clinician orders a test to detect immunoglobulin G antibodies to Western equine encephalitis in a patient’s cerebrospinal fluid, confirming a diagnosis of encephalitis.
10. A lab analyst performs an immunoassay to evaluate a patient’s serum for antibodies to the Western equine encephalitis virus, aiding in the diagnosis of encephalitis.