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The CPT® Code 86694 refers to a non-specific type test for antibodies against the herpes simplex virus (HSV). This test is performed on a sample of blood or cerebrospinal fluid to detect the presence of antibodies that indicate exposure to the virus. Herpes simplex virus is primarily transmitted through direct contact, and the initial infection often manifests as ulcerations on the skin or mucous membranes. After the primary infection, the virus can enter a latent phase, remaining dormant in the body and potentially reactivating due to various triggers such as other illnesses, infections, or stress. Certain populations, including neonates and individuals with compromised immune systems, are particularly vulnerable to severe complications, including ocular or central nervous system infections. Various testing methodologies exist for diagnosing HSV infections, including indirect hemagglutination (IHA), chemiluminescent immunoassay, and enzyme-linked immunosorbent assay (ELISA). The test typically involves measuring immunoglobulin G (IgG) and immunoglobulin M (IgM) levels to confirm the presence of HSV. It is important to note that if both IgG and IgM tests are conducted, each test should be reported separately. The code 86694 is specifically designated for non-specific type HSV testing, while codes 86695 and 86696 are used for tests that identify specific types of HSV, namely type 1 and type 2, respectively. Additionally, these codes can also be utilized to report the presence of glycoprotein G-specific antibodies for HSV type 1 and/or type 2.
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The non-specific type test for antibodies to the herpes simplex virus (HSV) is indicated for the following conditions:
The procedure for conducting the non-specific type HSV antibody test involves several key steps:
Post-procedure care for patients undergoing the non-specific type HSV antibody test is generally minimal, as the procedure involves a standard blood draw or cerebrospinal fluid collection. Patients may be advised to monitor for any unusual symptoms following the test, especially if they are part of an at-risk population. Results are typically communicated to the patient by their healthcare provider, who will discuss the implications of the findings and any necessary follow-up actions or treatments based on the test results.
| Short Descr | HERPES SIMPLEX NES ANTBDY | Medium Descr | ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST | Long Descr | Antibody; herpes simplex, non-specific type test | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 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. | 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 | 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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| 2013-01-01 | Changed | Short Descriptor changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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