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The CPT® Code 86592 refers to a qualitative syphilis test that detects non-treponemal antibodies in the blood. This test is crucial for diagnosing syphilis, a sexually transmitted disease caused by the bacterium Treponema pallidum. The qualitative nature of this test means it determines the presence or absence of antibodies rather than measuring their quantity. Commonly used qualitative tests include the Venereal Disease Research Laboratory (VDRL) test, the Rapid Plasma Reagin (RPR) test, and the Automated Reagin Test (ART). These tests work by measuring the body's antibody response to lipoidal antigens that are released during the infection or by assessing the interaction of antibodies with host tissues. Syphilis progresses through several stages, starting with a primary stage characterized by the appearance of a chancre, which is a painless sore at the site of infection. This sore typically resolves on its own within three to six weeks, but the infection persists if left untreated. The secondary stage may follow, marked by systemic symptoms such as a skin rash, mucous membrane lesions, fever, and swollen lymph nodes. If the infection remains untreated, it can lead to a latent stage where symptoms may not manifest for many years, potentially resulting in severe complications affecting various organs, including the brain and heart. The qualitative test is often the first step in syphilis screening. If the initial test yields a positive result, it is typically followed by a confirmatory test to ensure accuracy. Should the confirmatory test also be positive, quantitative testing may be conducted to assess disease activity and monitor treatment response. This quantitative assessment can be performed using methods such as the enzyme-linked immunosorbent assay (ELISA). It is important to note that both qualitative and quantitative tests can be conducted on blood samples, and in cases where central nervous system involvement is suspected, cerebrospinal fluid (CSF) may be tested instead.
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The qualitative syphilis test (CPT® Code 86592) is indicated for the following conditions:
The procedure for conducting the qualitative syphilis test involves several key steps:
After the qualitative syphilis test is completed, the patient may be advised on the next steps based on the test results. If the test is positive, the healthcare provider will typically discuss the need for confirmatory testing and potential treatment options. It is essential for patients to understand the implications of a positive result, including the importance of notifying sexual partners and the need for follow-up care. In cases where treatment is initiated, patients will be monitored for response to therapy and any potential side effects. Additionally, patients should be educated about the risks of syphilis transmission and the importance of regular screening, especially for those in high-risk groups or during pregnancy.
| Short Descr | SYPHILIS TEST NON-TREP QUAL | Medium Descr | SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL | Long Descr | Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | 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 | Service Paid under Fee Schedule or Payment System other than OPPS | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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. | 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 | 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. | 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. | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | FP | Service provided as part of family planning program | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | QW | Clia waived test | SL | State supplied vaccine | U6 | Medicaid level of care 6, as defined by each state | 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 | 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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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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