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The CPT® Code 86803 refers to a laboratory test specifically designed to measure antibodies against the Hepatitis C virus (HCV). This test is crucial for identifying individuals who may be infected with HCV, which is known to cause both acute and chronic liver inflammation. Hepatitis C can be transmitted through various means, including blood transfusions, needle sticks, sharing needles in both occupational and recreational contexts, unprotected sexual contact, and even from mother to child during pregnancy. Additionally, personal items such as razors or toothbrushes can also pose a risk for transmission. The test associated with code 86803 is particularly important for screening individuals who are at higher risk for HCV infection. The testing process involves obtaining a blood sample through a procedure known as venipuncture, which must be reported separately. The serum obtained from the blood sample is then analyzed using a qualitative chemiluminescent immunoassay, a method that detects the presence of antibodies. It is important to note that antibodies to HCV may not be detectable until approximately two months after exposure; therefore, if there is a strong suspicion of HCV infection despite a negative test result, it is recommended that the screening be repeated. Furthermore, if the antibody screen yields a positive result, it is essential to confirm this finding with additional testing, which is reported under CPT® Code 86804, utilizing a recombinant immunoblot assay for more definitive results.
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The Hepatitis C antibody test, coded as CPT® 86803, is indicated for individuals who are at risk for infection with the Hepatitis C virus (HCV). The following conditions and situations warrant the performance of this test:
The procedure for conducting the Hepatitis C antibody test involves several key steps, which are outlined below:
After the Hepatitis C antibody test is performed, the patient may be advised on the next steps based on the test results. If the test result is negative, and there is a high suspicion of HCV infection, the healthcare provider may recommend retesting after a specified period. In the case of a positive result, further confirmatory testing is required, which is reported under CPT® Code 86804. This follow-up testing is crucial for accurate diagnosis and management of the patient's condition. Additionally, the healthcare provider may discuss potential treatment options and lifestyle modifications to reduce the risk of transmission and manage the infection effectively.
| Short Descr | HEPATITIS C AB TEST | Medium Descr | HEPATITIS C ANTIBODY | Long Descr | Hepatitis C antibody; | 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) | Yes | 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 | 1 | 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. | QW | Clia waived test | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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. | GW | Service not related to the hospice patient's terminal condition | 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | 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. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | SA | Nurse practitioner rendering service in collaboration with a physician | SL | State supplied vaccine | 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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| 2010-01-01 | Changed | Code description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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