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The CPT® Code 86381 refers to the testing for mitochondrial antibodies, specifically the M2 type, which are crucial in the diagnosis of primary biliary cholangitis (PBC). This autoimmune condition is characterized by the gradual destruction of the bile ducts within the liver, resulting from chronic inflammation. Over time, this destruction leads to irreversible scarring of liver tissue, ultimately culminating in liver failure if left untreated. The presence of antimitochondrial M2 antibodies (AMAs) in the blood serves as a significant indicator of PBC, with over 90% of patients diagnosed with this condition testing positive for these antibodies. The test is particularly relevant for individuals who exhibit symptoms such as chronic itching (pruritus), fatigue, abdominal pain, or unexplained biochemical evidence of cholestasis, which is often indicated by elevated alkaline phosphatase (ALP) levels. Furthermore, certain risk factors, including having an autoimmune disorder, a family history of PBC, the use of nail polish, hormone replacement therapy, and cigarette smoking, can increase the likelihood of developing this disease. The testing process typically involves obtaining a venous blood sample, which is then analyzed for the presence of AMAs using various methods, including indirect immunofluorescence, immunoblotting, enzyme immunoassays, luminex bead assays, and enzyme inhibition assays. The reliability of a positive AMA test result, particularly at a titer greater than 1:40, makes it a critical component in the diagnostic evaluation of patients suspected of having PBC.
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The mitochondrial antibody (M2) test, represented by CPT® Code 86381, is indicated for the following conditions and symptoms:
The procedure for testing mitochondrial antibodies (M2) involves several key steps, which are outlined as follows:
After the mitochondrial antibody test is completed, patients may be advised to resume normal activities immediately, as there are typically no significant post-procedure restrictions. The healthcare provider will discuss the results with the patient once they are available, which may take several days. If the test result is positive, further diagnostic evaluations or treatment options may be considered based on the patient's overall clinical picture and symptoms. It is important for patients to follow up with their healthcare provider to understand the implications of the test results and to discuss any necessary next steps in their care.
| Short Descr | MITOCHONDRIAL ANTIBODY EACH | Medium Descr | MITOCHONDRIAL ANTIBODY EACH | Long Descr | Mitochondrial antibody (eg, M2), each | 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 | 4 |
| 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | 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 | Q3 | Live kidney donor surgery and related services |
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| 2022-01-01 | Added | Code added |
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