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The CPT® Code 86593 refers to a quantitative syphilis test that detects non-treponemal antibodies in the blood. Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. The disease progresses through several stages, starting with the primary stage characterized by the appearance of a sore known as a chancre at the site of infection. Although the chancre typically resolves on its own within 3 to 6 weeks, the individual remains infected. If left untreated, syphilis can advance to the secondary stage, which may present with a variety of symptoms including a skin rash, particularly on the palms and soles, as well as fever, swollen lymph nodes, sore throat, hair loss, headaches, weight loss, muscle aches, and fatigue. These secondary symptoms may also resolve spontaneously, but the infection persists. As the disease progresses, individuals may enter a latent stage where symptoms may not manifest for a decade or two. In the late stage of syphilis, serious complications can arise, including difficulties in muscle coordination, paralysis, numbness, gradual blindness, and dementia, as the infection can severely damage internal organs such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Particularly concerning is the risk of undiagnosed syphilis during pregnancy, as the infection can be transmitted to the fetus, leading to stillbirth or neonatal death shortly after birth. Infants who survive may face significant health challenges, including developmental delays or seizures. The quantitative test indicated by CPT® Code 86593 is performed following a positive qualitative screening test, such as the venereal disease research laboratory (VDRL) test, rapid plasma reagin (RPR) test, or automated reagin test (ART). These qualitative tests measure the antibody response to lipoidal antigens from T. pallidum and/or the interaction of antibodies with host tissues. Quantitative testing, which may utilize enzyme-linked immunosorbent assay (ELISA), is essential for assessing disease activity and monitoring treatment response. 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.
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The quantitative syphilis test, represented by CPT® Code 86593, is indicated for the following conditions:
The procedure for conducting the quantitative syphilis test involves several key steps:
After the quantitative syphilis test is performed, patients may not require any specific post-procedure care. However, it is essential for healthcare providers to communicate the results to the patient and discuss any necessary follow-up actions. If the test indicates active syphilis infection, appropriate treatment options should be discussed, and the patient may need to be monitored for any potential complications. In cases where treatment is initiated, follow-up testing may be scheduled to ensure that antibody levels are decreasing, indicating a successful response to therapy. Additionally, patients should be educated about the importance of informing sexual partners and practicing safe sex to prevent further transmission of the infection.
| Short Descr | SYPHILIS TEST NON-TREP QUANT | Medium Descr | SYPHILIS TEST QUANTITATIVE | Long Descr | Syphilis test, non-treponemal antibody; quantitative | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | Q4 | Service for ordering/referring physician qualifies as a service exemption | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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. | 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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 |
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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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