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Antineutrophil cytoplasmic antibodies (ANCA) are specific proteins produced by the immune system that target antigens located in the cytoplasmic granules of certain white blood cells, particularly neutrophils and monocytes. The presence of these antibodies is significant in the context of autoimmune diseases, particularly those that involve vasculitis, which is the inflammation of blood vessels. There are two primary types of ANCAs: perinuclear stained antineutrophil antibodies (pANCA), which specifically target the enzyme myeloperoxidase, and cytoplasmic stained antineutrophil antibodies (c-ANCA), which target proteinase 3. The testing for these antibodies is crucial in diagnosing various forms of autoimmune vasculitis, such as Wegener’s granulomatosis, polyarteritis nodosa, and microscopic polyangiitis. These conditions can lead to serious complications as they cause inflammation and swelling in blood vessels, affecting blood flow and potentially damaging organs. The test involves obtaining a venous blood sample, which is then analyzed using an indirect immunofluorescent antibody test to detect the presence of the specific antibodies ordered, including c-ANCA, p-ANCA, and atypical p-ANCA. The CPT® Code 86036 is used to report the screening test that provides qualitative results indicating the presence or absence of each antibody, while CPT® Code 86037 is designated for a titer test that offers semi-quantitative results for each antibody.
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Antineutrophil cytoplasmic antibody (ANCA) screening is indicated for the evaluation of suspected autoimmune vasculitis conditions. The following are specific indications for performing this test:
The procedure for ANCA screening involves several key steps to ensure accurate testing and results. First, a venous blood sample is collected from the patient. This sample is essential as it contains the serum that will be tested for the presence of ANCAs. Following the collection, the serum is subjected to an indirect immunofluorescent antibody test. This specific testing method allows for the identification of the antibodies present in the serum. The test is designed to detect both c-ANCA and p-ANCA, as well as atypical p-ANCA, depending on the specific antibodies ordered by the healthcare provider. The results of this screening test are reported qualitatively, indicating whether each type of antibody is present or absent in the patient's serum. It is important to note that if a more detailed analysis is required, such as determining the concentration of the antibodies, a titer test can be performed, which is reported under CPT® Code 86037.
After the ANCA screening procedure, there are no specific post-procedure care requirements for the patient, as the test is a simple blood draw. However, it is essential for healthcare providers to discuss the results with the patient once they are available. If the test results indicate the presence of ANCAs, further evaluation and management may be necessary to address any underlying autoimmune conditions. Additionally, if a titer test was performed, the healthcare provider may need to interpret the semi-quantitative results to assess the severity of the condition and guide treatment decisions. Regular follow-up may be required based on the clinical context and the patient's overall health status.
| Short Descr | ANCA SCREEN EACH ANTIBODY | Medium Descr | ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB | Long Descr | Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | none | MUE | 3 |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2022-01-01 | Added | Code added |
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