How To Use CPT Code 86704

CPT 86704 describes the evaluation of a patient’s specimen for total hepatitis B core antibodies using an immunoassay method. 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 86704?

CPT 86704 can be used to evaluate a patient’s specimen, typically serum, for total hepatitis B core antibodies. This test provides a total result of all immunoglobulin types present in the patient’s blood. It is performed using an immunoassay method, such as enzyme-linked immunosorbent assay (ELISA), to detect the antigen-antibody reaction.

2. Official Description

The official description of CPT code 86704 is: ‘Hepatitis B core antibody (HBcAb); total.’

3. Procedure

1. The lab analyst collects a specimen, typically serum, from the patient.
2. The specimen is tested using an immunoassay method, such as ELISA, to detect the presence of hepatitis B core antibodies.
3. The test may involve reacting the specimen with test antigens, incubating the mixture, and adding an agent 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 86704 may be ordered by clinicians when a patient exhibits symptoms of general ill health, continuous mild fever, body aches, loss of appetite, nausea, vomiting, dark urine, or jaundice. It may also be ordered for patients with high-risk behaviors for hepatitis, such as intravenous drug use, unprotected sex with multiple partners, or being a healthcare worker.

5. When to use CPT code 86704

CPT code 86704 should be used when a clinician specifically wants to test for total hepatitis B core antibodies. It is important to choose the correct code based on the specific antigen or antibody being tested for. For example, if the provider is testing for the HBcAb IgM antibody, CPT code 86705 should be used. If the provider is testing for the hepatitis B surface antibody, CPT code 86706 should be used.

6. Documentation requirements

To support a claim for CPT 86704, the clinician must document the following information:

• Patient’s symptoms or high-risk behaviors warranting the test
• Specific immunoassay method used, such as ELISA
• Date of specimen collection
• Interpretation of the test results
• Signature of the clinician ordering the test

7. Billing guidelines

When billing for CPT 86704, ensure that the test is performed using an immunoassay method and that the documentation requirements are met. It is important to choose the correct code based on the specific antigen or antibody being tested for. Some payers may also separately reimburse for specimen collection using a code such as 36415.

8. Historical information

CPT 86704 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders CPT 86704 to evaluate a patient’s serum for total hepatitis B core antibodies due to persistent symptoms of general ill health.
2. A patient with high-risk behaviors for hepatitis, such as intravenous drug use, undergoes CPT 86704 to test for total hepatitis B core antibodies.
3. A healthcare worker is required to undergo CPT 86704 as part of routine screening for hepatitis B.
4. A clinician orders CPT 86704 for a patient with continuous mild fever, body aches, and loss of appetite to rule out hepatitis B infection.
5. A patient with persistent jaundice undergoes CPT 86704 to evaluate for the presence of hepatitis B core antibodies.
6. A clinician orders CPT 86704 for a patient with nausea, vomiting, and dark urine to assess for possible hepatitis B infection.
7. A patient with a history of unprotected sex with multiple partners undergoes CPT 86704 to test for total hepatitis B core antibodies.
8. A clinician orders CPT 86704 for a patient with persistent flu-like symptoms to rule out hepatitis B infection.
9. A patient with a history of intravenous drug use undergoes CPT 86704 to evaluate for the presence of hepatitis B core antibodies.
10. A clinician orders CPT 86704 for a healthcare worker who experiences continuous mild fever and body aches to assess for possible hepatitis B infection.