How To Use CPT Code 86800

CPT 86800 describes the immunoassay procedure used to evaluate a patient’s serum for antibodies to thyroglobulin, a protein produced by the thyroid gland. 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 86800?

CPT 86800 is a code used to describe the immunoassay procedure performed by a lab analyst to evaluate a patient’s serum for antibodies to thyroglobulin. This test helps clinicians diagnose and differentiate autoimmune thyroid disorders from other thyroid conditions. By detecting the presence of antibodies to thyroglobulin, the test can indicate the presence of autoimmune diseases such as Hashimoto thyroiditis or Graves disease.

2. Official Description

The official description of CPT code 86800 is: ‘Thyroglobulin antibody.’

3. Procedure

1. A lab analyst collects a sample of the patient’s serum.
2. The analyst performs an immunoassay using an enzyme-linked immunosorbent assay (ELISA) or a similar method to test the sample for antibodies to thyroglobulin.
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 86800 is typically ordered by clinicians to help diagnose and differentiate autoimmune thyroid disorders. It is used when there is a suspicion of Hashimoto thyroiditis or Graves disease, which are characterized by the presence of antibodies to thyroglobulin. The test is not limited to these conditions and can be used to evaluate other autoimmune or non-autoimmune thyroid disorders.

5. When to use CPT code 86800

CPT code 86800 should be used when a clinician orders an immunoassay to test a patient’s serum for antibodies to thyroglobulin. It is appropriate when there is a clinical suspicion of autoimmune thyroid disorders or when monitoring thyroglobulin levels in patients with thyroid cancer. This code should not be used for antigen detection.

6. Documentation requirements

To support a claim for CPT 86800, the documentation should include:

• Reason for ordering the test and the suspected diagnosis
• Details of the immunoassay method used, such as ELISA
• Date of the test
• Interpretation of the results (positive, negative, or semiquantitative value)
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86800, ensure that the immunoassay is performed to evaluate the patient’s serum for antibodies to thyroglobulin. This code should not be reported for antigen detection. It is important to follow payer-specific guidelines and include any necessary modifiers or additional documentation to support the claim.

8. Historical information

CPT 86800 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with symptoms of fatigue and weight gain undergoes an immunoassay to test for antibodies to thyroglobulin, which comes back positive, indicating a possible autoimmune thyroid disorder.
2. A patient with a history of thyroid cancer undergoes regular monitoring of thyroglobulin levels using an immunoassay to ensure the absence of antibodies that could interfere with the accuracy of the test.
3. A clinician suspects an autoimmune thyroid disorder in a patient with elevated thyroid-stimulating hormone (TSH) levels and orders an immunoassay to test for antibodies to thyroglobulin, which comes back negative, ruling out the presence of autoimmune antibodies.
4. A patient presents with symptoms of hyperthyroidism, and an immunoassay is performed to test for antibodies to thyroglobulin, which comes back positive, confirming the diagnosis of Graves disease.
5. A patient with a family history of autoimmune thyroid disorders undergoes an immunoassay to screen for antibodies to thyroglobulin, which comes back negative, indicating a lower risk of developing such conditions.