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CPT® Code 86317 refers to an immunoassay procedure specifically designed for the quantitative measurement of antibodies against infectious agents. This code is utilized when a blood test is conducted to assess the levels of antibodies present in the patient's serum, which can indicate exposure to various infectious agents. The term "quantitative" signifies that the test provides a numerical value representing the concentration of antibodies, allowing healthcare providers to evaluate the immune response to specific pathogens. Common infectious agents tested under this code include Toxoplasma gondii, tetanus, rubella, diphtheria, Haemophilus influenzae type B, Streptococcus pneumoniae (14 serotypes), and hepatitis B surface antibodies. The testing is often performed using advanced techniques such as quantitative multi-analyte fluorescent detection, which enhances the accuracy and reliability of the results. It is important to note that this code is distinct from CPT® Code 86318, which is used for qualitative or semiquantitative immunoassays that identify infectious agent antibodies through simpler methods, such as dipstick or reagent strip methodologies, typically yielding results within a short timeframe of 5-10 minutes.
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The use of CPT® Code 86317 is indicated for the quantitative measurement of antibodies in patients who may have been exposed to specific infectious agents. This testing is essential for diagnosing and monitoring various infectious diseases. The following conditions and scenarios may warrant the use of this code:
The procedure associated with CPT® Code 86317 involves several key steps to ensure accurate quantitative measurement of antibodies in the patient's blood sample. The following outlines the procedural steps:
After the immunoassay procedure associated with CPT® Code 86317, the patient may not require any specific post-procedure care, as the blood draw is a routine procedure. However, healthcare providers should ensure that patients are informed about when they can expect to receive their test results. It is also important to discuss the implications of the results with the patient, including any necessary follow-up actions based on the antibody levels measured. In cases where antibody levels are low or absent, further evaluation or vaccination may be recommended to enhance immunity against the infectious agents tested.
| Short Descr | IMMUNOASSAY INFECTIOUS AGENT | Medium Descr | IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS | Long Descr | Immunoassay for infectious agent antibody, quantitative, not otherwise specified | 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 | 6 | 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. | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | GW | Service not related to the hospice patient's terminal condition | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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. | 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. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q4 | Service for ordering/referring physician qualifies as a service exemption | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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Notes
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| 2022-01-01 | Changed | First appearance of guideline addition and change in codebook. |
| 2020-10-06 | Changed | Guideline addition and change |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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