How To Use CPT Code 86804

CPT 86804 describes the confirmatory test for Hepatitis C antibodies using a method such as immunoblot. 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 86804?

CPT 86804 can be used to confirm the presence of antibodies to Hepatitis C (HCV) in a patient’s blood. This code is specifically for the confirmatory test, which utilizes methods like immunoblot to detect and identify the antibodies associated with HCV infection.

2. Official Description

The official description of CPT code 86804 is: ‘Hepatitis C antibody; confirmatory test (eg, immunoblot).’

3. Procedure

1. A lab analyst performs a confirmatory test to detect the presence of antibodies to Hepatitis C in the patient’s blood.
2. The analyst may use a method such as immunoblot, also known as Western blot, to confirm the presence of specific antibodies.
3. The test may involve steps like electrophoresis to separate the target antigens, transferring the separated antigens to a blot, and applying the patient’s serum to the blot.
4. If specific antibodies to HCV are present in the patient’s serum, they will bind to the corresponding antigens on the blot.
5. A dye is then added to reveal the presence of the antibodies, confirming the patient’s infection with HCV.

4. Qualifying circumstances

CPT 86804 is typically ordered by clinicians to definitively diagnose and confirm infection with Hepatitis C in patients who have previously tested positive for HCV antibodies. This test is not limited to specific conditions and can be used to confirm HCV infection in various patient populations.

5. When to use CPT code 86804

CPT code 86804 should be used when a confirmatory test is required to confirm the presence of antibodies to Hepatitis C. It is important to note that this code is specifically for the confirmatory test and should not be used for antigen detection. If antigen detection is necessary, other codes such as 87520 to 87522 should be used instead.

6. Documentation requirements

To support a claim for CPT 86804, the documentation should include:

• Reason for ordering the confirmatory test
• Details of the specific method used, such as immunoblot
• Date and time of the test
• Results of the test, including the presence or absence of HCV antibodies
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 86804, it is important to ensure that the test is performed using a confirmatory method such as immunoblot. This code should not be reported for antigen detection. Additionally, some payers may separately reimburse for specimen collection using a code like 36415. It is important to review payer guidelines and follow appropriate coding and billing practices.

8. Historical information

CPT 86804 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient previously tested positive for HCV antibodies, and a confirmatory test using immunoblot was performed to confirm the presence of Hepatitis C infection.
2. A clinician ordered a confirmatory test for a patient with risk factors for HCV infection, and the immunoblot test confirmed the presence of HCV antibodies.
3. A patient with symptoms suggestive of Hepatitis C underwent a confirmatory test using immunoblot, which confirmed the presence of HCV antibodies and the diagnosis of HCV infection.
4. A patient who had a positive HCV antibody test during routine screening underwent a confirmatory test using immunoblot, which confirmed the presence of HCV antibodies and the need for further evaluation and treatment.
5. A patient with a history of HCV exposure and a previous positive HCV antibody test underwent a confirmatory test using immunoblot, which confirmed the presence of HCV antibodies and the need for ongoing monitoring and management.