Pathology/Lab Coding Alert

Question: When our lab performs a Treponema pallidum antibody test to diagnose syphilis infection for a patient who has not had a prior test, should we report 86781?

Washington Subscriber

Answer: Starting Jan. 1, you should report a new CPT 2010 code for the test you describe: 86780 (Antibody; Treponema pallidum). This new code solves a longstanding problem that your question illuminates.

Problem: Prior to the introduction of 86780, the only code CPT provided for Treponema pallidum was a confirmatory test: 86781 (Antibody; Treponema pallidum, confirmatory test [e.g., FTA-abs]). Because the primary test that labs used to identify Syphilis infection sometimes has false positives (86592, Syphilis test; qualitative [e.g., VDRL, RPR, ART]), physicians would order 86781 to confirm the diagnosis.

Current coding: Some labs prefer to offer Treponema pallidum antibody as the primary test to diagnose Syphilis because it is more specific and perhaps easier to run. "With the new code, physicians can now order the antibody test for the initial diagnosis and labs will have a code to bill for the test," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Keep existing code: If your lab runs a confirmatory Treponema pallidum antibody test, you should continue to report 86781.