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Question: We are currently seeing a greater than normal amount of requests to conduct lab tests for Lyme disease. CPT^® lists a number of tests for Borrelia burgdorferi, the bacterium transmitted by tick bites that causes the disease. Which ones should we be using and why?

New York Subscriber

Answer: The Centers for Disease Control and Prevention (CDC) recommends and, indeed, requires, “a two-step testing process for Lyme disease serologic testing” that “can be done using the same blood sample.” They go on to elaborate that “If this first step is negative, no further testing is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The overall result is positive only when the first test is positive (or equivocal) and the second test is positive (or for some tests equivocal).”

For the CDC, “standard two-tier testing (STTT) uses enzyme immunoassay (EIA) as the first step and western blotting (WB) for the second step. Increasingly, laboratories are using modified two-tier testing (MTTT) in which both assays are EIAs.”

Currently, you’ll report STTT for Lyme disease using the following CPT^® codes:

• 86618 (Antibody; Borrelia burgdorferi (Lyme disease)), which is a enzyme-linked immunoassay (ELISA) for the B. burgdorferi antibody, and
• 86617 (Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot))

But Know These Other Lyme Test Codes

CPT^® lists several other tests you can use to detect the Borrelia burgdorferi antigen.

• 87475 (Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, direct probe technique)
• 87476 (… amplified probe technique)

However, you should note that these tests are most accurate when the sample used is not blood but joint fluid. For this reason, the less invasive antibody tests described above are the preferred testing modality.

You’ll also find the following proprietary laboratory analyses (PLA) that you may purchase from a specific manufacturer or send off to a specific lab for analysis:

• 0041U (Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM) for the Lyme ImmunoBlot IgM test by IGeneX Inc., ID-FISH Technology Inc. (ASR)
• 0042U (Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by immunoblot, IgG) for the Lyme ImmunoBlot IgG test by IGeneX Inc., ID-FISH Technology Inc. (ASR)
• 0316U (Borrelia burgdorferi (Lyme disease), OspA protein evaluation, urine) for the Lyme Borrelia Nanotrap^® Urine Antigen test by Galaxy Diagnostics Inc.

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