How To Use CPT Code 86794

CPT 86794 describes the evaluation of a patient’s serum for immunoglobulin M (IgM) antibodies to Zika virus using an immunoassay. 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 86794?

CPT 86794 can be used to evaluate a patient’s serum for the presence of immunoglobulin M (IgM) antibodies to Zika virus. This code is used when a lab analyst performs an immunoassay to detect the antibodies in the patient’s blood. The test helps diagnose Zika virus infection in patients with symptoms such as fever, rash, headache, or joint pain, or to assess the risk of birth defects in asymptomatic pregnant patients who may have been exposed to the virus.

2. Official Description

The official description of CPT code 86794 is: ‘Antibody; Zika virus, IgM.’

3. Procedure

1. The lab analyst collects a patient’s blood specimen for testing.
2. The specimen is evaluated using an immunoassay method, such as enzyme-linked immunosorbent assay (ELISA), to detect the presence of Zika virus-specific IgM antibodies.
3. The test involves various steps, including reacting the specimen with test antigens, incubating the mixture, adding a marker to detect the antigen-antibody complex, and interpreting the results as positive, negative, or semiquantitative.
4. The lab analyst interprets the test results and reports them to the healthcare provider.

4. Qualifying circumstances

CPT 86794 is used when there is a clinical suspicion of Zika virus infection based on the patient’s symptoms or potential exposure. The test is typically ordered by clinicians to aid in the diagnosis of Zika virus infection or to assess the risk of birth defects in pregnant patients. It is important to note that this code specifically refers to the detection of IgM antibodies to Zika virus and should not be used for Zika antigen detection.

5. When to use CPT code 86794

CPT code 86794 should be used when a healthcare provider orders a test to evaluate a patient’s serum for Zika virus-specific IgM antibodies. This code is appropriate when there is a clinical suspicion of Zika virus infection or when assessing the risk of birth defects in pregnant patients. It is important to use this code only for the detection of IgM antibodies and not for Zika antigen detection.

6. Documentation requirements

To support a claim for CPT code 86794, the healthcare provider must document the following information:

• Clinical indication for the test, such as symptoms or potential exposure to Zika virus
• Details of the immunoassay method used, including the specific test antigens and markers
• Date of specimen collection
• Test results, reported as positive, negative, or semiquantitative
• Interpretation of the test results
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 86794, ensure that the test is performed to detect Zika virus-specific IgM antibodies using an immunoassay method. It is important to note that some payers may separately reimburse for specimen collection using a different code, such as 36415. Additionally, do not use CPT code 86794 for Zika antigen detection; instead, use the appropriate code, such as 87662.

8. Historical information

CPT code 86794 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A pregnant patient with a history of travel to a Zika-affected area presents with rash and joint pain. The healthcare provider orders CPT code 86794 to evaluate the patient’s serum for Zika virus-specific IgM antibodies.
2. A patient with symptoms of fever and headache recently returned from a Zika-affected area. The healthcare provider orders CPT code 86794 to determine if the patient has been infected with Zika virus.
3. An asymptomatic pregnant patient with potential exposure to Zika virus through sexual contact undergoes testing with CPT code 86794 to assess the risk of birth defects.
4. A patient presents with symptoms of fever, rash, and joint pain, and has a history of travel to a Zika-affected area. The healthcare provider orders CPT code 86794 to aid in the diagnosis of Zika virus infection.
5. A pregnant patient with no symptoms but a history of travel to a Zika-affected area undergoes testing with CPT code 86794 to assess the risk of Zika-related birth defects.
6. A patient with symptoms of fever and headache, and a recent history of travel to a Zika-affected area, is tested using CPT code 86794 to confirm or rule out Zika virus infection.
7. An asymptomatic pregnant patient with potential exposure to Zika virus through travel undergoes testing with CPT code 86794 to assess the risk of birth defects.
8. A patient presents with symptoms of fever, rash, and joint pain, and has a history of travel to a Zika-affected area. The healthcare provider orders CPT code 86794 to aid in the diagnosis of Zika virus infection.
9. A pregnant patient with no symptoms but a history of travel to a Zika-affected area undergoes testing with CPT code 86794 to assess the risk of Zika-related birth defects.
10. A patient with symptoms of fever and headache, and a recent history of travel to a Zika-affected area, is tested using CPT code 86794 to confirm or rule out Zika virus infection.