How To Use CPT Code 86695

CPT 86695 describes the antibody test for herpes simplex, type 1. 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 86695?

CPT 86695 can be used to describe the antibody test for herpes simplex, type 1. This code is used when a lab analyst performs an immunoassay to evaluate the patient’s serum or cerebrospinal fluid (CSF) for antibodies to type 1 herpes simplex (HSV-1).

2. Official Description

The official description of CPT code 86695 is: ‘Antibody; herpes simplex, type 1.’

3. Procedure

1. The lab analyst performs an immunoassay to evaluate the patient’s serum or CSF for antibodies to type 1 herpes simplex (HSV-1).
2. The test may include various steps such as reacting the specimen with test beads coated with HSV-1 antigens and fluorescent markers, incubating and washing the mixture, and passing the beads through a detector that measures the amount of fluorescence and HSV-1 antibody present.
3. The analyst interprets the results as positive, negative, or as a semiquantitative value.

4. Qualifying circumstances

Patients who may require the antibody test for herpes simplex, type 1 are those who are suspected of having an infection with HSV-1. This test can help diagnose or rule out possible infection with HSV-1, which may cause cold sores or more severe diseases such as encephalitis. The test is performed on the patient’s serum or CSF by a lab analyst using an immunoassay method.

5. When to use CPT code 86695

CPT code 86695 should be used when a lab analyst performs an antibody test for herpes simplex, type 1 on a patient’s serum or CSF. This code is specific to HSV-1 and should not be used for other types of herpes simplex or nonspecific antibody tests.

6. Documentation requirements

To support a claim for CPT code 86695, the lab analyst must document the following information:

• Patient’s suspected diagnosis or reason for ordering the test
• Method used for the immunoassay, such as multiplex flow immunoassay
• Interpretation of the test results as positive, negative, or semiquantitative

7. Billing guidelines

When billing for CPT code 86695, ensure that the test is performed by a lab analyst and that the patient’s serum or CSF is tested for antibodies to herpes simplex, type 1. This code should not be reported with other codes for different types of herpes simplex or nonspecific antibody tests. Some payers may also separately reimburse for the collection of the specimen using a venipuncture code.

8. Historical information

CPT code 86695 was added to the Current Procedural Terminology system on January 1, 1993. There was a code change on January 1, 2002, where the description was updated to specify ‘herpes simplex, type 1.’

9. Examples

1. A lab analyst performs an antibody test for herpes simplex, type 1 on a patient’s serum, and the results are positive.
2. During an evaluation for possible HSV-1 infection, a lab analyst tests a patient’s CSF for antibodies to herpes simplex, type 1, and the results are negative.
3. A patient with a history of cold sores undergoes an antibody test for herpes simplex, type 1, and the results show a semiquantitative value indicating a previous infection.
4. As part of a diagnostic workup for encephalitis, a lab analyst performs an antibody test for herpes simplex, type 1 on a patient’s CSF, and the results are positive.
5. A patient with suspected HSV-1 infection undergoes an antibody test for herpes simplex, type 1, and the results are inconclusive, requiring further testing.
6. During a routine check-up, a lab analyst tests a patient’s serum for antibodies to herpes simplex, type 1, and the results are negative.
7. A patient with recurrent cold sores undergoes an antibody test for herpes simplex, type 1, and the results confirm the presence of antibodies.
8. As part of a follow-up for encephalitis treatment, a lab analyst performs an antibody test for herpes simplex, type 1 on a patient’s CSF, and the results are negative.
9. A patient with suspected HSV-1 infection undergoes an antibody test for herpes simplex, type 1, and the results are positive, confirming the diagnosis.
10. During a diagnostic workup for a suspected HSV-1 infection, a lab analyst tests a patient’s serum for antibodies to herpes simplex, type 1, and the results are inconclusive, requiring further evaluation.