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The CPT® Code 86804 refers to a confirmatory test for Hepatitis C antibodies, specifically utilizing methods such as the immunoblot technique. This laboratory test is crucial for accurately diagnosing Hepatitis C virus (HCV) infections, which can lead to significant liver inflammation, either in an acute or chronic form. Hepatitis C is primarily transmitted through blood, making it a concern in various scenarios, including blood transfusions, needle stick injuries, and the sharing of needles, particularly in both occupational settings and among individuals using recreational drugs. Additionally, the virus can be spread through unprotected sexual contact, from mother to child during pregnancy, or through the sharing of personal items that may come into contact with blood, such as razors or toothbrushes. The confirmatory test represented by CPT® Code 86804 is performed following an initial screening test, which is reported under CPT® Code 86803. The screening test is designed to identify individuals who are at risk for HCV infection. A blood sample is collected through a procedure known as venipuncture, which is separately reportable. The serum obtained from the blood sample is then analyzed using a qualitative chemiluminescent immunoassay to detect the presence of antibodies against HCV. It is important to note that antibodies may not be detectable until approximately two months post-exposure, which necessitates retesting in cases where there is a strong clinical suspicion of HCV infection despite a negative initial screening result. If the screening test yields a positive result, it is essential to confirm this finding with the more specific test coded as 86804, which employs the recombinant immunoblot assay to ensure accurate diagnosis.
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The confirmatory test for Hepatitis C antibodies, represented by CPT® Code 86804, is indicated in the following scenarios:
The procedure for conducting the confirmatory test for Hepatitis C antibodies involves several key steps:
After the confirmatory test is performed, the patient may be advised on the next steps based on the test results. If the test confirms the presence of Hepatitis C antibodies, further evaluation and management will be necessary, which may include additional testing to determine the viral load and genotype. Patients should be informed about the importance of follow-up appointments and potential treatment options. It is also essential to provide counseling regarding the transmission of Hepatitis C and preventive measures to avoid spreading the virus to others.
| Short Descr | HEP C AB TEST CONFIRM | Medium Descr | HEPATITIS C ANTIBODY CONFIRMATORY TEST | Long Descr | Hepatitis C antibody; confirmatory test (eg, immunoblot) | 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 | 1 | CCS Clinical Classification | 235 - Other Laboratory |
| 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. | 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. | GW | Service not related to the hospice patient's terminal condition |
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| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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