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The CPT® Code 86430 refers to a laboratory test that measures the qualitative levels of rheumatoid factor in a patient's blood. Rheumatoid factor is an antibody that can be present in various autoimmune diseases, particularly rheumatoid arthritis. The test is designed to detect the presence of these antibodies, which can indicate an autoimmune response. The qualitative aspect of this test means that it determines whether rheumatoid factor is present or absent, rather than measuring the exact quantity of the antibodies. Elevated levels of rheumatoid factor can be associated with several conditions, including rheumatoid arthritis, hepatitis C, Sjogren syndrome, and other chronic infections. To perform this test, a blood sample is collected through a procedure known as venipuncture, which is separately reportable. The serum obtained from the blood sample is then analyzed using a semiquantitative enzyme-linked immunosorbent assay (ELISA), a common laboratory technique that allows for the detection of specific proteins, such as antibodies, in the serum.
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The rheumatoid factor qualitative test (CPT® Code 86430) is indicated for the evaluation of various autoimmune conditions and chronic infections. The following conditions may warrant the performance of this test:
The procedure for conducting the rheumatoid factor qualitative test involves several key steps to ensure accurate results. First, a healthcare professional will perform venipuncture, which is the process of puncturing a vein to obtain a blood sample. This step is crucial as it provides the serum needed for testing. Once the blood is drawn, it is collected into a sterile container and allowed to clot, after which the serum is separated from the blood cells through centrifugation. The serum is then subjected to a semiquantitative enzyme-linked immunosorbent assay (ELISA). This laboratory technique involves adding specific reagents to the serum that will bind to any rheumatoid factor present. The results of the test will indicate whether rheumatoid factor is present in a qualitative manner, meaning it will show a positive or negative result based on the presence of the antibodies.
After the rheumatoid factor qualitative test is completed, the patient may experience minimal to no discomfort from the venipuncture. There are typically no specific post-procedure care instructions required for the patient, although they may be advised to apply pressure to the puncture site to minimize any potential bruising. The results of the test will be analyzed and reported back to the healthcare provider, who will interpret the findings in the context of the patient's overall clinical picture. If rheumatoid factor is detected, further evaluation and management may be necessary based on the underlying condition being investigated.
| Short Descr | RHEUMATOID FACTOR TEST QUAL | Medium Descr | RHEUMATOID FACTOR QUALITATIVE | Long Descr | Rheumatoid factor; qualitative | 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 | 2 | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | GW | Service not related to the hospice patient's terminal condition | 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. | 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. | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | 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 | QW | Clia waived test | 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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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
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