How To Use CPT Code 86790

CPT 86790 describes the procedure for detecting virus antibodies that do not have a specific code. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86790?

CPT 86790 can be used to report procedures that detect virus antibodies which do not have a specific code. This code is used when there is no other specific procedure or service code available to accurately describe the service provided.

2. Official Description

The official description of CPT code 86790 is: ‘Antibody; virus, not elsewhere specified.’

3. Procedure

1. The lab analyst performs an immunoassay to evaluate the patient’s sample for antibodies to a virus that is not represented by any of the standard and active CPT codes available.

4. Qualifying circumstances

CPT 86790 is used when there is no specific code available to accurately describe the detection of virus antibodies. It is important to note that this code should only be used when there is no other appropriate code that closely approximates the service provided.

5. When to use CPT code 86790

CPT code 86790 should be used when there is no specific code available to accurately describe the detection of virus antibodies. It is important to follow CPT guidelines and choose the appropriate unlisted procedure code when no specific procedure or service code exists.

6. Documentation requirements

To support a claim for CPT 86790, it is important to include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Relevant documentation should also be included to strengthen the claim and avoid possible denial. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

7. Billing guidelines

When billing for CPT 86790, it is important to submit a cover letter explaining the reason for choosing the unlisted code. Include one or more similar codes and compare the service to those codes to justify the claim amount. Additionally, include relevant documentation to support the claim. It is important to note that Category III codes should be reported when available in place of an unlisted procedure code.

8. Historical information

CPT 86790 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 lab analyst performs an immunoassay to detect antibodies to a newly discovered virus that does not have a specific code.
2. A patient’s sample is evaluated for antibodies to a rare virus that is not represented by any of the standard CPT codes.
3. An immunoassay is performed to detect antibodies to a virus that is not covered by any of the active CPT codes.
4. A lab technician conducts an immunoassay to identify antibodies to a virus that does not have a specific code.
5. A patient’s sample is tested for antibodies to a virus that is not included in the existing CPT codes.
6. An immunoassay is performed to detect antibodies to a virus that does not have a designated code.
7. A lab analyst evaluates a patient’s sample for antibodies to a virus that is not represented by any of the available CPT codes.
8. A rare virus is tested for antibodies using an immunoassay that does not have a specific code.
9. An immunoassay is conducted to detect antibodies to a virus that is not covered by any of the standard CPT codes.
10. A patient’s sample is analyzed for antibodies to a virus that does not have a specific code.