Overview
CPT® code 86038 is used to report a laboratory test that detects antinuclear antibodies (ANAs) in a patient’s serum. ANAs are autoantibodies that target the nuclei of cells and are commonly associated with autoimmune disorders. The ANA screen is a critical diagnostic tool in evaluating systemic autoimmune diseases such as systemic lupus erythematosus (SLE), scleroderma, and Sjögren’s syndrome.
When to Use CPT 86038
Use CPT 86038 when screening patients for suspected autoimmune conditions. It is often ordered in response to symptoms like chronic fatigue, joint pain, rash, or unexplained inflammation. This test is typically the first step in an autoimmune workup and may be followed by more specific antibody tests if positive.
Key Requirements
- Requires a serum specimen for analysis.
- Ordered when there is clinical suspicion of an autoimmune disorder.
- The test is qualitative—indicating whether ANAs are present or absent.
- Documentation should include the patient’s symptoms or clinical indications supporting the test.
Billing Guidelines
- Report 86038 for a qualitative ANA screen only.
- If a positive result leads to additional antibody identification (e.g., anti-dsDNA, anti-Smith), use CPT 86039 for each additional antibody tested.
- Do not report both 86038 and 86039 for the same antibody.
- Include medical necessity documentation describing suspected autoimmune disease.
Example Clinical Scenarios
- A patient presents with persistent joint pain, fatigue, and skin rashes—an ANA test helps screen for lupus.
- A provider evaluates a patient with dry eyes and mouth to rule out Sjögren’s syndrome.
- A patient with abnormal inflammatory markers undergoes ANA screening to assess for possible autoimmune causes.
Summary
CPT® code 86038 identifies qualitative screening for antinuclear antibodies, a key step in diagnosing autoimmune disorders. This test provides valuable diagnostic insight when evaluating systemic inflammatory and connective tissue diseases.
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