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The CPT® Code 86231 refers to the laboratory test for endomysial antibodies (EMA), which are specific autoantibodies produced in response to gluten, a protein found in wheat, barley, rye, and oats. This test is primarily utilized in the diagnosis of celiac disease, also known as celiac sprue, a condition characterized by an abnormal immune reaction to gluten that leads to damage of the small intestine's villi. The presence of these antibodies indicates an immune response that can result in malabsorption of essential nutrients, leading to various gastrointestinal and systemic symptoms. Common symptoms associated with celiac disease include recurring abdominal pain, bloating, and changes in bowel habits such as chronic diarrhea or constipation, often accompanied by pale, foul-smelling stools. Patients may also experience weight loss and iron deficiency anemia due to nutrient malabsorption. The EMA test specifically targets immunoglobulin A (IgA) antibodies, which are highly specific for celiac disease. In cases where patients have IgA deficiency, testing for immunoglobulin G (IgG) antibodies may be performed as an alternative. The test is conducted using a venous blood sample, and the serum is analyzed through the indirect immunofluorescent antibody (IFA) technique, providing a qualitative result. It is important to note that the accuracy of the EMA test is contingent upon the patient’s continued consumption of gluten; if gluten is eliminated from the diet, the antibody response may not be present, leading to potentially misleading results. Additionally, the EMA test may be less sensitive in individuals with mild celiac disease or in children under the age of 2 years, and it is often used in conjunction with other immunoassays to confirm the diagnosis of celiac disease.
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The endomysial antibody (EMA) test is indicated for the following conditions:
The procedure for conducting the endomysial antibody (EMA) test involves several key steps:
After the endomysial antibody (EMA) test is performed, the patient may resume normal activities immediately, as there are no specific post-procedure care requirements. However, it is essential for the patient to continue their gluten-containing diet until the test is completed to ensure the accuracy of the results. The healthcare provider will discuss the test results with the patient, and if the EMA test is positive, further evaluation and management for celiac disease may be necessary. In cases of negative results, additional testing or monitoring may be recommended based on the patient's symptoms and clinical history.
| Short Descr | EMA EACH IG CLASS | Medium Descr | ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS | Long Descr | Endomysial antibody (EMA), each immunoglobulin (Ig) class | 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. | 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. | 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. | 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 | 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 |
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| 2022-01-01 | Added | Code added |
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