CPT® Code 86653

Official Description

Antibody; encephalitis, St. Louis

Common Language Description

The CPT® Code 86653 refers to a laboratory test specifically designed to measure antibodies associated with St. Louis encephalitis in serum and/or cerebrospinal fluid (CSF). St. Louis encephalitis is a viral infection transmitted by mosquitoes, predominantly found in regions such as the Western United States, Texas, the Ohio-Mississippi Valley, and Florida. This disease tends to have peak outbreak periods during the summer and autumn months. Initial symptoms of St. Louis encephalitis can include fever, chills, headache, and malaise, with additional symptoms such as sleepiness, nausea, sore throat, and cough potentially manifesting. Following the onset of these early symptoms, central nervous system (CNS) symptoms may develop within 1 to 4 days, which can persist for months or even years. The risk of experiencing CNS symptoms is notably higher in elderly patients, who may exhibit signs such as irritability, sleepiness, depression, and memory loss. The laboratory test measures IgG antibody titers, which can indicate either current or past infections, while IgM antibodies are indicative of current or recent infections. It is essential to consider the patient's travel history, along with relevant medical and epidemiological data, particularly in cases where the virus has not been isolated. The test requires a blood sample, which is obtained through a separately reportable venipuncture, and CSF, which is collected via a separately reportable lumbar puncture. The analysis of serum and CSF is conducted using semi-quantitative indirect fluorescent antibody or immunofluorescent assay techniques.

1. Indications

The procedure associated with CPT® Code 86653 is indicated for the evaluation of suspected St. Louis encephalitis infection. The following conditions and symptoms warrant the performance of this laboratory test:

Fever A common initial symptom that may indicate an infectious process.
Chills Often accompanying fever, chills can suggest an ongoing infection.
Headache A frequent complaint in patients with viral infections, including encephalitis.
Malaise General feelings of discomfort or illness that may accompany other symptoms.
Sleepiness Increased drowsiness can be a sign of CNS involvement.
Nausea May occur as a result of the infection affecting the CNS.
Sore throat Can be present in conjunction with other systemic symptoms.
Cough Sometimes reported in patients with St. Louis encephalitis.
Central Nervous System Symptoms Such as irritability, sleepiness, depression, and memory loss, particularly in elderly patients.

2. Procedure

The procedure for CPT® Code 86653 involves several critical steps to ensure accurate measurement of St. Louis encephalitis antibodies in serum and cerebrospinal fluid (CSF). The first step is obtaining a blood sample through a process known as venipuncture. This procedure is performed by inserting a needle into a vein, typically in the arm, to collect the necessary serum for testing. It is important to note that this venipuncture is separately reportable, meaning it should be documented and billed independently from the antibody test itself.

Following the collection of serum, the next step involves obtaining CSF, which is done through a lumbar puncture. This procedure entails inserting a needle into the lower back to access the spinal canal and collect CSF. Like the venipuncture, the lumbar puncture is also separately reportable and must be documented accordingly. Once both serum and CSF samples are collected, they are subjected to testing using semi-quantitative indirect fluorescent antibody or immunofluorescent assay techniques. These assays are designed to detect the presence of IgG and IgM antibodies specific to St. Louis encephalitis, providing crucial information regarding current or past infections.

3. Post-Procedure

After the completion of the procedures for obtaining serum and CSF, patients may experience some discomfort at the venipuncture or lumbar puncture sites. It is essential to monitor for any adverse reactions, such as excessive bleeding or signs of infection at the puncture sites. Patients should be advised to rest and hydrate adequately following the procedures. The results of the antibody tests will typically be available after a specified period, and healthcare providers should follow up with patients to discuss the findings and any necessary further actions based on the results. Additionally, it is important to consider the patient's clinical presentation and history when interpreting the test results, as this will guide further management and treatment decisions.

Short Descr	ENCEPHALTIS ST LOUIS ANTBODY
Medium Descr	ANTIBODY ENCEPHALITIS ST. LOUIS
Long Descr	Antibody; encephalitis, St. Louis
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.
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.
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service