Clinical Context
A 28-year-old patient presents to a gastroenterology clinic with several months of intermittent diarrhea, bloating, unexplained iron-deficiency anemia, and weight loss. The gastroenterologist suspects celiac disease. Initial evaluation includes a clinical history, physical exam, and serologic testing. A blood sample is sent to the laboratory for an immunoassay to detect antibodies to deamidated gliadin peptides (DGP), such as DGP IgA and DGP IgG, billed with 86258.
The typical workflow: the clinician orders the DGP antibody test when celiac disease is suspected or when monitoring adherence to a gluten‑free diet in a previously diagnosed patient. A phlebotomy draw is performed in the outpatient clinic or an ambulatory laboratory. The specimen (serum) is transported to the lab; testing is performed via ELISA or similar immunoassay. Results are reported in the electronic health record to the ordering provider. Positive DGP IgA and/or IgG results support further evaluation for celiac disease, often paired with total serum IgA, tissue transglutaminase antibodies, and, where indicated, referral for duodenal biopsy. Typical sites of service include outpatient physician offices, ambulatory laboratory centers, and hospital outpatient laboratories. Service type: laboratory diagnostic immunoassay.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
80053 | Comprehensive metabolic panel | Common baseline laboratory panel ordered concurrently to evaluate anemia, electrolyte abnormalities, and liver function when celiac disease is suspected. |
82784 | Ferritin or 82728 may be used depending on lab — Ferritin measurement | Ferritin testing assesses iron stores and helps evaluate iron-deficiency anemia often associated with celiac disease; frequently ordered with DGP testing.
83516 | Tissue transglutaminase (tTG) antibody, IgA | tTG IgA is a primary serologic test for celiac disease and is often ordered alongside 86258 to increase diagnostic sensitivity.
85025 | Complete blood count (CBC) with automated differential | CBC evaluates for anemia and other hematologic abnormalities that can prompt celiac workup.
88305 | Level III surgical pathology, gross and microscopic examination | If serology suggests celiac disease, an endoscopic duodenal biopsy may be performed and billed with pathology services such as 88305 for histologic evaluation of villous atrophy.
81002 | Urinalysis, non-automated, without microscopy | Sometimes part of initial outpatient diagnostic evaluation for nonspecific symptoms; ordered concurrently in ambulatory workups.