How To Use CPT Code 86735

CPT 86735 describes the laboratory procedure for evaluating a patient’s serum for antibodies to the mumps virus. 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 86735?

CPT 86735 can be used to describe the laboratory procedure performed by a lab analyst to evaluate a patient’s serum for antibodies to the mumps virus. This test helps determine if the patient has been exposed to the mumps virus and has developed antibodies as part of their immune response.

2. Official Description

The official description of CPT code 86735 is: ‘Antibody; mumps.’

3. Procedure

1. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to the mumps virus.
2. The analyst uses an indirect immunofluorescence assay, where diluted samples are placed in reaction wells containing mumps virus infected slides.
3. If antibodies are present in the sample, they will bind with the antigen present in the slides, forming an antigen-antibody complex.
4. The analyst adds a fluorescent antibody marker to the complex, making it visible under a microscope using ultraviolet illumination.
5. The presence of a glow from the fluorescent marker indicates the presence of mumps antibodies in the patient’s serum.

4. Qualifying circumstances

CPT 86735 is typically ordered by clinicians when there is suspicion of mumps infection or parotitis, which is characterized by swelling of the parotid glands. It may also be ordered to determine if a patient who received the MMR vaccine has developed the mumps antibody and is now immune. The test is performed on the patient’s serum, and the results help in diagnosing mumps infection or assessing immunity.

5. When to use CPT code 86735

CPT code 86735 should be used when a clinician orders a laboratory test to evaluate a patient’s serum for antibodies to the mumps virus. It is appropriate to use this code when the test is performed to diagnose mumps infection or assess immunity after vaccination.

6. Documentation requirements

To support a claim for CPT 86735, the documentation should include:

• Reason for ordering the test, such as suspicion of mumps infection or assessment of immunity
• Details of the laboratory procedure performed, including the use of an immunoassay and the specific method used (indirect immunofluorescence assay)
• Date of the test
• Results of the test, indicating the presence or absence of mumps antibodies
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86735, ensure that the test is performed by a qualified lab analyst and that the documentation supports the medical necessity of the test. It is important to note that this code is specifically for antibody detection and should not be used for antigen detection. Additionally, some payers may separately reimburse for specimen collection using a different code, such as 36415 for venous blood collection.

8. Historical information

CPT 86735 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 clinician orders CPT 86735 to evaluate a patient’s serum for mumps antibodies after the patient presents with symptoms of parotitis, including swelling of the parotid glands and pain when chewing.
2. A patient who received the MMR vaccine undergoes CPT 86735 to determine if they have developed the mumps antibody and are now immune.
3. A clinician suspects mumps infection in a patient with fever, headache, and testicular swelling, and orders CPT 86735 to confirm the diagnosis.
4. A patient presents with symptoms suggestive of mumps, and CPT 86735 is performed to assess their immune response to the virus.
5. A clinician orders CPT 86735 as part of a comprehensive evaluation for a patient with suspected mumps infection, including other laboratory tests and clinical assessment.
6. A patient with a history of mumps infection undergoes CPT 86735 to assess their antibody levels and determine if they require additional vaccination.
7. A clinician orders CPT 86735 for a patient with suspected mumps infection, and the test results confirm the presence of mumps antibodies in the patient’s serum.
8. A patient presents with symptoms of parotitis, and CPT 86735 is performed to rule out mumps infection as the cause.
9. A clinician orders CPT 86735 for a patient who experienced swelling of the parotid glands and wants to confirm if it is due to mumps infection.
10. A patient with a history of mumps infection undergoes CPT 86735 to assess their immune response and determine if they are still protected against the virus.