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The CPT® Code 86631 refers to the laboratory test for antibodies to Chlamydia, a genus of bacteria responsible for various infections in humans. The most notable species within this genus is Chlamydia trachomatis, which is primarily known for causing sexually transmitted diseases (STDs). This particular infection often remains asymptomatic, meaning that individuals may not exhibit any noticeable symptoms. However, if left untreated, it can lead to severe complications, particularly in women, including irreversible damage to the reproductive system, which may result in infertility. In men, while the infection can cause symptoms such as burning and itching in the urethra, they are less likely to experience long-term reproductive issues. In addition to C. trachomatis, the Chlamydia genus includes C. pneumoniae, which is associated with respiratory infections such as pneumonia, bronchitis, rhinitis, and pharyngitis. Another species, C. psittaci, primarily affects birds but can be transmitted to humans through contact with infected birds, leading to flu-like symptoms. Testing for Chlamydia antibodies can be performed using various methods, including the indirect fluorescent antibody test and the enzyme-linked immunosorbent assay (ELISA). The CPT® Code 86631 is specifically designated for screening tests that detect antibodies for all species of Chlamydia and for tests that identify IgG antibodies. For tests that identify IgM antibodies, the CPT® Code 86632 should be used. It is important to note that each species and each immunoglobulin class (IgG, IgM) tested is reported separately, ensuring precise and accurate laboratory results.
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The CPT® Code 86631 is indicated for the testing of antibodies to Chlamydia in various clinical scenarios. The following conditions and situations warrant the use of this test:
The procedure for testing antibodies to Chlamydia using CPT® Code 86631 involves several key steps, which are outlined below:
After the antibody testing for Chlamydia using CPT® Code 86631, patients may receive specific instructions based on their results. If the test is positive, healthcare providers may recommend further diagnostic testing, treatment options, and counseling regarding safe sexual practices to prevent reinfection. In cases where the test is negative, providers may still discuss the importance of regular screenings, especially for individuals at high risk. Additionally, patients should be informed about the potential for false negatives and the importance of follow-up testing if symptoms persist or if there is a high suspicion of infection despite negative results. Overall, post-procedure care focuses on ensuring patient understanding and addressing any ongoing health concerns related to Chlamydia infections.
| Short Descr | CHLAMYDIA ANTIBODY | Medium Descr | ANTIBODY CHLAMYDIA | Long Descr | Antibody; Chlamydia | 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 | 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. | 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 | 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. | 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. | G8 | Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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