CPT 86023: Platelet-Associated Immunoglobulin Detection
CPT code 86023 represents a laboratory immunology test that detects and identifies platelet-associated immunoglobulins. Nationally, this test is used in the evaluation of suspected immune-mediated thrombocytopenia and other platelet disorders where antibody binding to platelets is clinically relevant. The code captures the technical laboratory work performed to analyze patient blood specimens for platelet-bound immunoglobulins.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the assay, typical sites of service, and the types of benchmarks and policy topics commonly associated with specialized laboratory testing. The publication summarizes standard utilization considerations, coding context, and payer coverage themes relevant to CPT code 86023.
This summary does not include state-specific policy details. Data not available in the input will be identified as such in the relevant sections.
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Billing Code Overview
CPT code 86023 describes a laboratory test in which a lab analyst performs the technical procedures to detect and identify platelet-associated immunoglobulins in a patient’s blood. This assay evaluates whether immunoglobulins are bound to platelets, a finding that can inform the diagnosis of immune-mediated platelet disorders.
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Service type: Clinical laboratory immunology test (technical component)
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Typical site of service: Clinical laboratory or hospital laboratory performing specialized hematology/immunology testing
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Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to the hematology clinic with unexplained thrombocytopenia and mucocutaneous bleeding. The clinician orders laboratory evaluation to determine whether platelet-associated immunoglobulins are present to support a diagnosis of immune thrombocytopenic purpura (ITP) or other immune-mediated platelet destruction. A phlebotomy draw is performed in the outpatient lab; the specimen is labeled and transported to the hospital clinical immunology laboratory. The lab analyst performs 86023, a technical assay that detects and identifies platelet-associated immunoglobulins. Results are reported to the ordering hematologist, who integrates these findings with CBC, peripheral smear, and clinical history to confirm immune-mediated platelet loss or to pursue alternate etiologies such as drug-induced thrombocytopenia or post-transfusion purpura. Typical site of service is an outpatient clinical laboratory or hospital clinical laboratory within an ambulatory or inpatient setting. The service type is a clinical laboratory diagnostic immunology test performed by a certified medical technologist or lab analyst.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if applicable (rare for purely technical immunoassays). |
TC | Technical component | Use when billing only the technical component of the test, common when a reference lab performs the assay. |
90 | Reference (outside) laboratory | Use when the specimen is referred to an outside reference laboratory for 86023. |
91 | Repeat clinical diagnostic test | Use when the test is repeated on the same day for quality control or clinical reason. |
59 | Distinct procedural service | Use when 86023 is performed on a different specimen or for a distinct clinical reason on the same date of service. |
76 | Repeat procedure, same provider | Data not available in the input. |
52 | Reduced services | Use when the test is only partially performed or a reduced-technique version is billed. |
53 | Discontinued procedure | Use if specimen processing was begun but the test was discontinued and appropriately documented. |
90 | Reference (outside) laboratory | Use when the performing lab is outside the billing entity (duplicate entry removed if present in billing). |
91 | Repeat clinical diagnostic test | Use when repeat testing is clinically required (duplicate entry removed if present in billing). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Hematology | Hematologists order and interpret platelet antibody testing in thrombocytopenia workups. |
207K00000X | Clinical Pathology | Pathologists and clinical pathologists oversee lab testing quality and interpretation. |
1835P0301X | Clinical Laboratory Scientist | Medical technologists and laboratory scientists perform the assay and technical reporting. |
207L00000X | Laboratory Medicine | Specialists in laboratory medicine manage test validation and reference lab coordination. |
2080P0202X | Pediatric Hematology-Oncology | Pediatric hematologists may order platelet antibody testing for children with suspected ITP. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D69.3 | Immune thrombocytopenic purpura | Primary indication for platelet-associated immunoglobulin testing to detect antibody-mediated platelet destruction. |
D69.6 | Thrombocytopenia, unspecified | Used when thrombocytopenia is documented and immune etiology is being evaluated with 86023. |
D69.5 | Secondary thrombocytopenia | Relevant when thrombocytopenia is secondary to systemic disease or drugs and platelet antibodies are assessed. |
T45.1X5A | Adverse effect of antithrombotic/antiplatelet drugs, initial encounter | Considered when drug-induced platelet destruction is suspected and antibody testing helps differential diagnosis. |
D69.49 | Other immune thrombocytopenic conditions | Used for related immune-mediated platelet disorders where 86023 assists in evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
85025 | Complete blood count (CBC) with automated differential | Initial screening test to document thrombocytopenia and guide need for platelet antibody testing. |
85027 | Automated platelet count | Provides quantitative platelet count used alongside 86023 to assess severity of thrombocytopenia. |
85300 | Platelet function studies; platelet aggregation, each procedure | Performed when platelet dysfunction, rather than immune destruction, is suspected following 86023. |
86850 | Platelet crossmatch for transfusion | Used when immune-mediated platelet destruction is suspected and compatible platelet transfusion is considered. |
86140 | Antibody detection by solid phase (e.g., ELISA) | Alternative or complementary immunoassay methods that may be performed in the same immunology workflow as 86023. |