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.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | Use when only the professional component of a diagnostic lab test is billed separately by a physician/provider. |
52 | Reduced services | Use when the testing performed is partially reduced from the full service described by the code.
53 | Discontinued procedure | Use when specimen collection or testing was started but discontinued for patient safety or other documented reasons.
59 | Distinct procedural service | Use when multiple services are performed and 86258 represents a distinct test separate from other billed procedures.
90 | Reference (outside) laboratory | Use when the test is performed by an outside certified reference laboratory and billed by the performing lab.
91 | Repeat clinical diagnostic laboratory test | Use when the same test is repeated on the same day to confirm a result or due to an analytical issue.
TC | Technical component | Use when billing only the technical component of the test (laboratory instrumentation, personnel, and supplies).
QW | CLIA waived test | Use when the test meets CLIA waived status and is billed under that designation (rare for DGP ELISA; use only if applicable).
90 appears above; duplicate use is acceptable per payer guidance but use once per claim | See 90 | See 90
XU | Unusual non-overlapping service | Use when documentation supports that the test is distinct and not typically reported together with another test billed for the same encounter.
| Taxonomy Code | Specialty | Notes |
|---|
207RH0000X | Gastroenterology | Gastroenterologists commonly order 86258 when evaluating suspected celiac disease. |
207L00000X | Allergy & Immunology | Allergists/immunologists evaluate immune-mediated disorders and may order DGP antibodies.
207Q00000X | Clinical Pathology | Pathologists and clinical laboratory specialists oversee test performance and interpretation.
261QP2300X | Family Medicine | Primary care physicians frequently order initial serologic testing for celiac disease.
208D00000X | Internal Medicine | Internists commonly initiate and manage diagnostic workup including serologic tests.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
K90.0 | Celiac disease | Primary diagnosis for which 86258 (DGP antibody testing) is ordered to support diagnosis and monitor disease activity. |
R19.7 | Diarrhea, unspecified | A common presenting symptom prompting serologic testing for celiac disease.
D50.9 | Iron deficiency anemia, unspecified | Frequently associated with malabsorption in celiac disease; testing for DGP antibodies is indicated when anemia has no other clear cause.
K90.49 | Other intestinal malabsorption | Broader malabsorption disorders where DGP testing may assist in differential diagnosis.
R63.4 | Abnormal weight loss | Unintentional weight loss is a presenting feature that may prompt evaluation for celiac disease with 86258.
E66.9 | Obesity, unspecified | Included when provider evaluates atypical presentations; DGP testing may be part of a broader GI evaluation when symptoms overlap.
R14.0 | Abdominal distension (gaseous) | Bloating and abdominal distension are common celiac symptoms prompting serologic testing.
K52.9 | Noninfective gastroenteritis and colitis, unspecified | When differential includes inflammatory or immune-mediated GI disorders, DGP testing can be part of the serologic panel.
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.