Pathology/Lab Coding Alert

Question: Our lab performed an antibody test for Borrelia burgdorferi for a patient with suspected Lyme disease. I’ve been told to report 87476, but is that the correct code?

New Hampshire Subscriber

Answer: No, you should not list 87476 (Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique) for an antibody test. The 87476 lab test seeks to identify any antigen present in the specimen, indicating infection with the organism. The lab method for 87476 is nucleic acid amplified probe technique.

Antibody: In contrast, an antibody test seeks to identify protein(s) produced by the body in response to infection with the organism. Because the Borrelia burgdorferi antigen may be present in very low quantities in the serum, the Centers for Disease Control and Prevention (CDC) recommends two-tiered antibody testing for Lyme disease instead of an antigen-detection test.

In such cases, the first antibody test the lab performs is typically 86618 (Antibody; Borrelia burgdorferi (Lyme disease)). The common lab method for this test is enzyme-linked immunoassay (ELISA). Because this test is highly sensitive and therefore may result in a false positive, the CDC recommends a highly specific second test, 86617 (Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)). A positive result on both tests is considered diagnostic for Lyme disease.

Coder clue: To help you select the proper lab test code, you should always consider what you’re testing for (e.g., a specific chemical, an antibody …), as well as what lab method you use.