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The CPT® Code 86255 refers to the screening for antibodies to noninfectious agents using a fluorescent technique. This procedure is primarily utilized to detect the presence of specific antibodies in a patient's blood sample or cerebral spinal fluid (CSF). The screening is typically the first step in the diagnostic process, allowing healthcare providers to identify potential autoimmune disorders or other conditions that are not caused by infectious agents. If the screening indicates the presence of antibodies, a subsequent titer count may be performed using CPT® Code 86256 to quantify the level of these antibodies. The antibodies detected through this screening can be associated with various medical conditions, including celiac disease, premature ovarian failure, myasthenia gravis, and other autoimmune disorders. Additionally, this test can help assess exposure to environmental toxins that may lead to autoimmune diseases, as well as monitor conditions such as cancers, graft versus host disease following organ transplants, and myocardial infarction or other cardiac injuries. Furthermore, these antibody screenings and titers can serve as valuable markers for evaluating the effectiveness of immunosuppressant therapy in patients undergoing treatment for autoimmune conditions.
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The screening for antibodies to noninfectious agents using CPT® Code 86255 is indicated for various medical conditions and situations, including:
The procedure for screening antibodies to noninfectious agents involves several key steps, which are detailed as follows:
Post-procedure care for patients undergoing antibody screening typically involves monitoring for any immediate adverse reactions, especially if a lumbar puncture was performed. Patients may experience mild discomfort or headache following the procedure. It is important for healthcare providers to inform patients about potential symptoms and when to seek further medical attention. Additionally, the results of the antibody screening should be discussed with the patient, including any necessary follow-up tests or treatments based on the findings. If antibodies are present, further evaluation may be required to assess the underlying condition and determine appropriate management strategies.
| Short Descr | FLUORESCENT ANTIBODY SCREEN | Medium Descr | FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY | Long Descr | Fluorescent noninfectious agent antibody; screen, each antibody | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 6 - Laboratory Physician Interpretation Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | 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 | 5 | 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. | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | GC | This service has been performed in part by a resident under the direction of a teaching physician | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | GW | Service not related to the hospice patient's terminal condition | 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. | 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 | G8 | Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure | 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 | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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