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The CPT® Code 86038 refers to the testing for antinuclear antibodies (ANA), which involves obtaining a blood sample to screen for the presence of these antibodies or to measure their concentration, known as an ANA titer. Antinuclear antibodies are a specific type of auto-antibody that target the structures within the nucleus of cells, indicating a potential autoimmune response. Auto-antibodies are antibodies that mistakenly attack the body's own tissues, which can lead to various autoimmune disorders. The presence of antinuclear antibodies in the blood can suggest several conditions characterized by inflammation of body tissues, including systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison disease, vitiligo, pernicious anemia, glomerulonephritis, and pulmonary fibrosis. The testing process typically begins with a screening using an enzyme-linked immunosorbent assay (ELISA). If the screening yields a positive result, indicating the presence of antinuclear antibodies, a titer test is performed to determine the concentration of these antibodies. The titer is established by diluting the blood sample with saline solution in increasing amounts until the antibodies are no longer detectable, with results expressed in ratios such as 1:10, 1:20, 1:40, 1:80, etc. A higher second number in the ratio signifies a greater concentration of antinuclear antibodies in the blood.
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Screening for Autoimmune Disorders The test is performed to screen for the presence of antinuclear antibodies, which may indicate various autoimmune disorders.
Monitoring Disease Activity The measurement of ANA titer can help in monitoring the activity of autoimmune diseases and assessing treatment effectiveness.
Diagnostic Evaluation The presence of antinuclear antibodies is used in the diagnostic evaluation of conditions such as systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis, and other autoimmune diseases.
Step 1: Blood Sample Collection A blood sample is obtained from the patient, typically through venipuncture, to ensure an adequate volume for testing.
Step 2: Screening Test The collected blood sample is subjected to an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of antinuclear antibodies. This initial screening helps determine if further testing is necessary.
Step 3: Titer Testing (if positive) If the screening test is positive, indicating the presence of antinuclear antibodies, a titer test is performed. This involves diluting the blood sample with increasing amounts of saline solution and retesting until the antibodies are no longer detectable. The dilution process continues until a negative result is achieved, allowing for the determination of the highest dilution at which antibodies are still present.
Step 4: Reporting Results The results of the ANA titer are expressed in ratios, such as 1:10, 1:20, 1:40, 1:80, etc. The first number represents one part of blood, while the second number indicates the parts of saline solution used for dilution. A higher second number signifies a higher concentration of antinuclear antibodies in the blood.
After the procedure, the patient may be advised to wait for the results, which typically take a few days. There are no specific post-procedure care requirements, as the blood draw is a routine procedure. However, patients should be informed about the potential for follow-up testing or additional evaluations based on the results of the ANA screening and titer. It is essential for healthcare providers to discuss the implications of the test results with the patient, including any necessary next steps in diagnosis or treatment.
| Short Descr | ANTINUCLEAR ANTIBODIES | Medium Descr | ANTINUCLEAR ANTIBODIES ANA | Long Descr | Antinuclear antibodies (ANA); | 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) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 235 - Other Laboratory |
| 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | GW | Service not related to the hospice patient's terminal condition | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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 | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | QW | Clia waived test | SA | Nurse practitioner rendering service in collaboration with a physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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