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Question: A provider ordered tests for a patient with inflammatory bowel disease (IBD). The patient had a colonoscopy that came back inconclusive, so the provider wanted to test to see if the patient had ulcerative colitis (UC) or Crohn’s disease. How should we code this?

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Answer: Providers will test patients with IBD for the presence of antineutrophil cytoplasmic antibodies (ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) using blood samples. If perinuclear ANCA (pANCA) is found in the sample, but ASCA is not, then the patient has UC; whereas if the opposite is true, and ASCA is detected but not pANCA, then the patient has Crohn’s according to MedlinePlus.

Tests for the two antibodies are coded to 86671 (Antibody; fungus, not elsewhere specified) for ASCA and 86036 (Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody), which detects ANCA. Usually, the lab will run the ASCA test twice; once to detect the presence of pANCA and once to determine the absence of ASCA immunoglobulins IgA and IgG, which is consistent with UC. So, you will likely bill:

• 86036
• 86671 x 2

To choose the correct diagnosis codes for the conditions, you’ll begin with either K50- (Crohn's disease [regional enteritis]) or K51.8- (Other ulcerative colitis), adding 5^th or 6^th characters for the absence or presence of complications as appropriate.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC