Pathology/Lab Coding Alert

CPT's removal of 86586 from the "skin test" code family in 2005 was a boon for immunodeficiency coding -- but it left skin-test coding high and dry.

Now CPT 2008 gives you a solution when your lab performs a skin test for an unlisted antigen -- new code 86486 (Skin test; unlisted antigen, each).

CPT 2008 deletes 86586 (Unlisted antigen, each) and replaces it with two more specific options: 86486 and 86356 (Mononuclear cell antigen, quantitative [e.g., flow cytometry], not otherwise specified, each antigen).

CPT clarifies how to use these codes with a new text note that appears following 86580:

"86586 has been deleted. For skin testing, unlisted antigen, use 86486. For flow cytometry, quantitative, not otherwise specified, use 86356."

"New code 86486 essentially gives us back a way to report unlisted skin test antigens," says Karen Kavanaugh, RHIT, compliance auditor with Labcorp in Oklahoma City. In 2005, labs had lost the code to report an unlisted antigen skin test when CPT un-indented 86586, removing it from the skin-test code family.

For a full explanation of how to use 86356, see "3 Ways to Prepare Your Lab for -Unlisted Antigen- Changes" on page 2 of this issue.

CPT provides four skin-test codes in addition to the new unlisted antigen code. You should select the most specific code to describe the antigen your lab uses:

- 86485 -- Skin test; candida

- 86490 -- - coccidioidomycosis

- 86510 -- - histoplasmosis

- 86580 -- - tuberculosis, intradermal.

"You should report 86486 only for a skin test that is for an antigen other than candida, coccidioidomycosis, histoplasmosis or tuberculosis," Kavanaugh says.

Although a skin test such as 86580 involves an intradermal administration, the procedure code includes the injection.

Pitfall: Don't be tempted to report injection codes with 86485-86580. For instance, you should not report an administration code, such as 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), with 86580, says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo. The TB skin test includes the injection administration, Center says.