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The CPT® Code 86692 refers to a laboratory test specifically designed to measure antibodies related to the hepatitis delta agent (HDV). This test evaluates both total antibodies and immunoglobulin M (IgM) antibodies against the hepatitis delta virus. Hepatitis delta is classified as an RNA virus and is distinct from other hepatitis viruses such as Hepatitis A, B, and C. It is characterized as a sub-viral entity, meaning it cannot replicate independently and requires the presence of the Hepatitis B virus (HBV) for its replication process. The transmission of HDV can occur simultaneously with HBV infection, leading to co-infection, or it can occur later, resulting in a super-infection. The presence of HDV in individuals co-infected with HBV significantly increases the risk of severe liver complications, including cirrhosis, liver failure, and hepatocellular carcinoma (liver cancer). A positive result for total HDV antibodies may suggest either an acute or chronic infection with the virus. Furthermore, the measurement of IgM antibodies is crucial as it helps differentiate between active viral replication during an acute infection and the reactivation of a chronic infection. The test is performed on a blood sample, which is obtained through a venipuncture procedure that is reported separately. The serum is then analyzed for total antibodies using a qualitative enzyme immunoassay, while IgM antibodies are assessed using a specific enzyme immunoassay method.
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The CPT® Code 86692 is indicated for the following conditions and scenarios:
The procedure for conducting the test associated with CPT® Code 86692 involves several key steps:
After the procedure, patients may experience minimal discomfort at the venipuncture site, which typically resolves quickly. There are no specific post-procedure care instructions required for this test, but patients should be advised to monitor the site for any unusual symptoms, such as excessive bleeding or signs of infection. The results of the test will be communicated to the healthcare provider, who will discuss the implications of the findings and any necessary follow-up actions based on the patient's clinical context.
| Short Descr | HEPATITIS DELTA AGENT ANTBDY | Medium Descr | ANTIBODY HEP DELTA AGENT | Long Descr | Antibody; hepatitis, delta agent | 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. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | Q4 | Service for ordering/referring physician qualifies as a service exemption |
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| 2024-01-01 | Changed | Guideline information changed. |
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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