Pathology/Lab Coding Alert

Answer: CPT^® provides more specific codes for both antineutrophil cytoplasmic antibody (ANCA) and anti-Saccaromyces cerevisiae antibodies (ASCA) tests than the codes you mention.

Although 83516 (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method) is an appropriate code for an unlisted antibody immunoassay, you have a more specific code for ASCA. Saccaromyces cerevisiae is a fungus, so the more appropriate code is 86671 (Antibody; fungus, not elsewhere specified).

Prior to 2022, 86021 (Antibody identification; leukocyte antibodies) was appropriate for an ANCA test, but now you have the more specific code, 86036 (Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody), to describe the test.

Clinical: For patients with IBD who have inconclusive colonoscopy and imaging findings, clinicians may order ANCA and ASCA testing to help distinguish between the two forms of the condition, which are ulcerative colitis (UC) and Crohn’s disease. Specifically, the presence of perinuclear ANCA (pANCA) and the absence of ASCA IgA and IgG are consistent with UC, while the reverse is true of Crohn’s.

Each antibody: Testing to distinguish forms of IBD typically involves just pANCA and not other antibodies, such as cytoplasmic ANCA (cANCA). On the other hand, testing for both IgG and IgA ASCA antibodies is appropriate, and results in two antibody tests. If that describes your lab’s testing, you should report the work as follows:

• 86036
• 86671 x 2

Different: These tests won’t help clinicians distinguish between IBD and inflammatory bowel syndrome (IBS), a condition that has similar symptoms. Instead, clinicians may order a fecal calprotectin test to help distinguish these conditions. If your lab performs that test, you should report the work as 83993 (Calprotectin, fecal).