How To Use CPT Code 86703

CPT 86703 describes the immunoassay procedure used to evaluate a patient’s specimen for antibodies to HIV 1 or HIV 2. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86703?

CPT 86703 can be used to describe the immunoassay procedure performed by a lab analyst to evaluate a patient’s specimen, typically serum, for antibodies to HIV 1 or HIV 2. This code applies to a single result for either antibody.

2. Official Description

The official description of CPT code 86703 is: ‘Antibody; HIV-1 and HIV-2, single result.’

3. Procedure

1. The lab analyst performs an immunoassay to evaluate the patient’s specimen, typically serum, for antibodies to HIV 1 or HIV 2.
2. This test does not differentiate between the two subtypes of HIV.
3. The test may include various 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 as a semiquantitative value.

4. Qualifying circumstances

CPT 86703 is used when clinicians order this antibody HIV 1 and HIV 2 test to test for human immunodeficiency virus type 1 and 2, which cause AIDS. This test is not limited to testing for a specific condition and may be ordered if a patient has risk factors for AIDS or is experiencing symptoms of an immunocompromised condition.

5. When to use CPT code 86703

CPT code 86703 should be used when a clinician orders an immunoassay to evaluate a patient’s specimen for antibodies to HIV 1 or HIV 2. This code is used for a single result and does not differentiate between the two subtypes of HIV.

6. Documentation requirements

To support a claim for CPT 86703, the documentation should include:

• Patient’s risk factors for AIDS or symptoms of an immunocompromised condition
• Details of the immunoassay procedure performed
• Interpretation of the results as positive, negative, or semiquantitative

7. Billing guidelines

When billing for CPT 86703, ensure that the immunoassay procedure is performed to evaluate a patient’s specimen for antibodies to HIV 1 or HIV 2. This code should be reported for a single result and does not differentiate between the two subtypes of HIV. It is important to follow any additional guidelines provided by payers regarding specimen collection and reporting modifiers.

8. Historical information

CPT 86703 was added to the Current Procedural Terminology system on January 1, 1993. There was a code change on January 1, 2012, which updated the description to ‘Antibody; HIV-1 and HIV-2, single assay.’

9. Examples

1. A clinician orders CPT 86703 to evaluate a patient’s specimen for antibodies to HIV 1 or HIV 2.
2. A patient with risk factors for AIDS undergoes CPT 86703 to test for the presence of HIV 1 or HIV 2 antibodies.
3. A clinician orders CPT 86703 for a patient experiencing symptoms of an immunocompromised condition to rule out HIV 1 or HIV 2 infection.
4. A patient with a history of intravenous drug use undergoes CPT 86703 as part of routine screening for HIV 1 or HIV 2.
5. A clinician orders CPT 86703 for a patient with frequent infections to assess their immune status and screen for HIV 1 or HIV 2 antibodies.
6. A patient with night sweats and weight loss undergoes CPT 86703 to test for the presence of HIV 1 or HIV 2 antibodies.
7. A clinician orders CPT 86703 for a patient with multiple sexual partners to screen for HIV 1 or HIV 2 infection.
8. A patient with a history of unsafe sex undergoes CPT 86703 as part of routine HIV testing.
9. A clinician orders CPT 86703 for a patient with a same-sex partner to screen for HIV 1 or HIV 2 infection.
10. A patient with a history of practicing unsafe sex undergoes CPT 86703 to test for the presence of HIV 1 or HIV 2 antibodies.