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The CPT® Code 86738 refers to a laboratory test that measures antibodies specific to mycoplasma, a genus of bacteria known for its unique characteristics. Mycoplasma organisms are the smallest free-living entities and are notable for their lack of a cell wall surrounding their cell membrane. This absence of a cell wall renders them resistant to many common antibiotics, particularly those that target cell wall synthesis, such as penicillin and other beta-lactam antibiotics. Mycoplasma is implicated in a variety of infections, with Mycoplasma pneumoniae being a significant pathogen associated with 'atypical' pneumonia. This form of pneumonia is typically mild and self-limiting, presenting symptoms such as bronchitis, runny nose, and cough. In addition to respiratory infections, Mycoplasma pneumoniae can lead to ocular complications, including conjunctivitis, swelling of the optic disk, iritis, retinal hemorrhage, and optic neuropathy. Other species, such as Mycoplasma hominis and Ureaplasma urealyticum, are associated with sexually transmitted infections, leading to conditions like urethritis and vaginitis, and can be transmitted to newborns during childbirth. Infants and individuals with compromised immune systems are particularly vulnerable to chronic or severe infections caused by these organisms. Due to the difficulty in culturing mycoplasma, antibody testing becomes a crucial diagnostic tool to identify these bacteria as potential causes of illness. The test measures different types of antibodies: a positive IgM titer indicates a current or recent infection, while a positive IgG titer, which is found in over 50 percent of serum samples, suggests past exposure to the organism. Additionally, IgA antibody titers may be assessed alongside IgM and IgG to provide further diagnostic information. The blood sample required for this test is obtained through a separately reportable venipuncture, and serum is analyzed for IgM, IgG, and IgA antibodies using a semi-quantitative enzyme-linked immunosorbent assay (ELISA) method.
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The laboratory test associated with CPT® Code 86738 is indicated for the detection of mycoplasma antibodies in patients who may be experiencing symptoms related to mycoplasma infections. The following conditions and symptoms warrant the performance of this test:
The procedure for testing mycoplasma antibodies involves several key steps that ensure accurate results. The following outlines the procedural steps associated with CPT® Code 86738:
After the procedure, patients may be advised on any necessary follow-up based on the test results. If the test indicates a current infection, appropriate treatment options will be discussed. In cases of positive IgG results, healthcare providers may consider the patient's clinical history and symptoms to determine if further testing or monitoring is required. Patients should be informed about the potential for mild discomfort at the venipuncture site, which typically resolves quickly. Additionally, any significant findings from the antibody testing may necessitate further diagnostic evaluations or referrals to specialists, depending on the clinical context.
| Short Descr | MYCOPLASMA ANTIBODY | Medium Descr | ANTIBODY MYCOPLSM | Long Descr | Antibody; mycoplasma | 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. | 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 | 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. | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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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| 2004-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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