Pathology/Lab Coding Alert

Question: Our lab processed a serum specimen for a requested infectious mononucleosis rapid test, with negative results. The clinician then ordered a serum EBV antibody profile. How should we code the services?

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Answer: The infectious mononucleosis rapid test is actually a serum heterophile antibody test, typically using rapid slide agglutination. The correct code for the test is 86308 (Heterophile antibodies; screening).

Epstein-Barr virus (EBV) typically causes infectious mononucleosis (mono) and produces heterophile antibodies within three weeks of infection. These antibody levels decline in the ensuing weeks, meaning that a negative test is possible even if the patient has had an EBV infection.

Following a negative mono screen, the lab may test for a more specific EBV antibody profile if ordered by the clinician. This profile typically involves testing for EBV, Viral Capsid Antigen (VCA) IgM and EBV VCA IgG, as well as EBV Nuclear Antigen (EBNA).

You should report the EBV VCA IgG and IgM using two units of 86665 (Antibody; Epstein-Barr [EB] virus, viral capsid [VCA]). Code 86665 represents a single antibody test, so one code is appropriate for IgG and another for IgM.

For the EBNA, you should report 86664 (Antibody; Epstein-Barr [EB] virus, nuclear antigen [EBNA]).