How To Use CPT Code 86738

CPT 86738 describes the procedure for evaluating a patient’s serum for antibodies to mycoplasma using an immunoassay. 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 86738?

CPT 86738 can be used to evaluate a patient’s serum for antibodies to mycoplasma. This code is used when a lab analyst performs an immunoassay to test the patient’s serum for the presence of these antibodies. The test may involve 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.

2. Official Description

The official description of CPT code 86738 is: ‘Antibody; mycoplasma.’

3. Procedure

1. The lab analyst collects a specimen of the patient’s serum.
2. The analyst performs an immunoassay using an enzyme-linked immunosorbent assay (ELISA) or a similar method.
3. The test involves reacting the specimen with test antigens, incubating the mixture, and adding an agent to detect the antigen-antibody complex.
4. The analyst interprets the results as positive, negative, or as a semiquantitative value.

4. Qualifying circumstances

CPT 86738 is used when a patient’s serum is tested for antibodies to mycoplasma. This test may be ordered if a patient presents with symptoms such as chest pain, dry cough, sore throat, fever, headache, urethritis, penile or vaginal discharge, vaginal itching, pain during intercourse, or other indications that suggest a mycoplasma infection.

5. When to use CPT code 86738

CPT code 86738 should be used when a lab analyst performs an immunoassay to evaluate a patient’s serum for antibodies to mycoplasma. It is important to note that this code should not be used for antigen detection.

6. Documentation requirements

To support a claim for CPT 86738, the documentation should include:

• Indication for the test, such as symptoms or clinical suspicion of a mycoplasma infection
• Details of the immunoassay method used, such as ELISA
• Date of the test
• Results of the test, including whether it was positive, negative, or a semiquantitative value

7. Billing guidelines

When billing for CPT 86738, ensure that the test is performed by a lab analyst using an immunoassay method. It is important to note that some payers may separately reimburse for specimen collection using a different code. Additionally, do not report CPT 86738 for antigen detection.

8. Historical information

CPT 86738 was added to the Current Procedural Terminology system on January 1, 1993, with the description ‘Antibody; mycoplasma.’ There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs an immunoassay to evaluate a patient’s serum for antibodies to mycoplasma. The test results are positive, indicating a mycoplasma infection.
2. A patient presents with symptoms of chest pain, dry cough, and sore throat. The lab analyst performs an immunoassay to test the patient’s serum for antibodies to mycoplasma. The test results are negative, ruling out a mycoplasma infection.
3. A clinician suspects a mycoplasma infection in a patient with urethritis and penile discharge. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are positive, confirming the presence of a mycoplasma infection.
4. A patient complains of vaginal itching and pain during intercourse. The lab analyst performs an immunoassay to test the patient’s serum for antibodies to mycoplasma. The test results are negative, indicating no mycoplasma infection.
5. A patient presents with symptoms of fever, headache, and vaginal discharge. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are positive, suggesting a mycoplasma infection.
6. A patient with a history of mycoplasma infection undergoes a follow-up test. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are negative, indicating no current infection.
7. A patient with a persistent dry cough undergoes a mycoplasma antibody test. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are positive, suggesting a mycoplasma infection as the cause of the cough.
8. A patient with a sore throat and headache undergoes a mycoplasma antibody test. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are negative, ruling out a mycoplasma infection as the cause of the symptoms.
9. A patient with vaginal itching and pain during intercourse undergoes a mycoplasma antibody test. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are positive, indicating a mycoplasma infection as the cause of the symptoms.
10. A patient with a persistent dry cough undergoes a mycoplasma antibody test. The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to mycoplasma. The test results are negative, ruling out a mycoplasma infection as the cause of the cough.