How To Use CPT Code 86701

CPT 86701 describes the immunoassay procedure used to evaluate a patient’s serum for antibodies to HIV-1, the human immunodeficiency virus 1. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86701?

CPT 86701 can be used to describe the immunoassay procedure performed by a lab analyst to test a patient’s serum for antibodies to HIV-1. This test helps diagnose or rule out possible infection with HIV-1, the virus that causes AIDS. It is commonly ordered for patients at high risk or those experiencing symptoms such as weight loss, recurrent fever, or swollen lymph nodes.

2. Official Description

The official description of CPT code 86701 is: ‘Antibody; HIV-1.’

3. Procedure

1. The lab analyst performs an immunoassay using the patient’s serum to detect antibodies specific to HIV-1.
2. The immunoassay method, such as enzyme immunosorbent assay (EIA), is used to react the specimen with test antigens and incubate the mixture.
3. An agent, such as a stain or fluorescent marker, is added to detect the antigen-antibody complex.
4. The lab analyst interprets the results as positive, negative, or as a semiquantitative value.

4. Qualifying circumstances

CPT 86701 is used when clinicians order the test to diagnose or rule out possible infection with HIV-1. It is not limited to testing for a specific condition but is commonly ordered for patients at high risk or those experiencing symptoms associated with HIV-1 infection. The test evaluates the patient’s serum for antibodies specific to HIV-1, indicating exposure to the virus.

5. When to use CPT code 86701

CPT code 86701 should be used when a clinician orders the immunoassay test to evaluate a patient’s serum for antibodies to HIV-1. It is appropriate for patients at high risk or those presenting symptoms associated with HIV-1 infection. This code should not be used for testing antigens or for other organisms.

6. Documentation requirements

To support a claim for CPT 86701, the documentation should include:

• Patient’s clinical indication for the test, such as high-risk factors or symptoms
• Details of the immunoassay method used, such as EIA
• Date and time of the test
• Interpretation of the results as positive, negative, or semiquantitative

7. Billing guidelines

When billing for CPT 86701, ensure that the test is performed by a lab analyst using the patient’s serum. It should not be reported with other codes for antigen testing or specimen collection. Some payers may separately reimburse for specimen collection using a code such as 36415.

8. Historical information

CPT 86701 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 clinician orders CPT 86701 to evaluate a patient’s serum for antibodies to HIV-1 due to high-risk factors.
2. A patient presents with symptoms such as weight loss and swollen lymph nodes, leading the clinician to order CPT 86701 to rule out HIV-1 infection.
3. A patient with a history of IV drug use undergoes CPT 86701 to test for antibodies to HIV-1.
4. A clinician orders CPT 86701 for a patient who had a potential exposure to HIV-1 through sexual contact with an infected individual.
5. A patient with recurrent fevers undergoes CPT 86701 to evaluate for possible HIV-1 infection.
6. A clinician orders CPT 86701 for a patient with unexplained weight loss and suspected HIV-1 infection.
7. A patient with a known exposure to HIV-1 through a needlestick injury undergoes CPT 86701 to test for antibodies.
8. A clinician orders CPT 86701 for a patient with symptoms suggestive of acute HIV-1 infection.
9. A patient with a history of unprotected sexual intercourse undergoes CPT 86701 to evaluate for possible HIV-1 infection.
10. A clinician orders CPT 86701 for a patient with swollen lymph nodes and suspected HIV-1 infection.