Summary & Overview
CPT 86625: Campylobacter Antibody Immunoassay
CPT code 86625 represents an immunoassay performed by a laboratory analyst to detect antibodies to Campylobacter bacteria in a patient’s blood. This serologic test is used to support clinical evaluation for Campylobacter infection when direct detection methods are unavailable or to assess prior exposure. Nationally, accurate coding of laboratory infectious disease assays like CPT code 86625 affects laboratory reporting, payer adjudication, and public health surveillance.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the test, typical sites of service, and common billing considerations tied to laboratory immunoassays. The publication outlines expected use cases, coding nuances, and the role of serologic testing in diagnostic workflows.
This summary equips billing and compliance staff, laboratory managers, and clinicians with the information needed to identify when CPT code 86625 applies, understand payer coverage landscape at a national level, and locate further details on documentation and service definitions. Data not available in the input will be noted in the relevant sections of the full publication.
Billing Code Overview
CPT code 86625 describes an immunoassay for detection of antibodies to Campylobacter in a patient’s blood. This laboratory-based serologic test evaluates the immune response to Campylobacter bacteria to support diagnosis of recent or past infection.
Service Type: Laboratory diagnostic test (immunoassay)
Typical Site of Service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to an urgent care clinic with acute onset of watery diarrhea, abdominal cramping, low-grade fever, and recent consumption of undercooked poultry. The clinician obtains a history and performs a focused abdominal exam, then orders stool culture and serologic testing to evaluate for enteric pathogens. When stool sample is not available or has low yield, or when the clinician needs adjunct evidence of recent infection, the laboratory performs an immunoassay 86625 to detect antibodies to Campylobacter species in the patient’s blood. Typical workflow: clinician collects blood specimen, labels and sends it to the clinical laboratory; the lab analyst runs the 86625 immunoassay (often in the microbiology or serology section); results are reported in the electronic health record to the ordering clinician, who integrates serology with clinical presentation and other test results (stool PCR/culture, CBC) to inform diagnosis and management. Typical sites of service: hospital outpatient laboratory, independent clinical laboratory, urgent care, or hospital inpatient laboratory when the patient is admitted for severe symptoms. Typical patient scenario: adult with suspected bacterial enteritis where stool testing is inconclusive or delayed; serology used as adjunctive evidence of recent Campylobacter infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician/pathologist interpretation of the test separate from the laboratory technical component |
TC | Technical component | Use when billing only the laboratory technical component (equipment, technician) of the test |
90 | Reference (outside) laboratory | Use when the service is performed by an outside reference laboratory and billed by the ordering provider |
91 | Repeat clinical diagnostic test | Not in raw list; Data not available in the input. |
52 | Reduced services | Use when the assay is performed but a reduced service is provided (limited testing) |
53 | Discontinued procedure | Use when specimen collection or testing was started but discontinued for documented reasons |
59 | Distinct procedural service | Not in raw list; Data not available in the input. |
78 | Unplanned return to OR by same physician following procedure | Use rarely; if a specimen-driven procedure required reintervention — limited applicability |
90 | Reference (outside) laboratory | Duplicate entry avoided; use as above |
91 | Duplicate entry avoided | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Infectious Disease | Physicians ordering and interpreting serologic testing for infectious enteric diseases |
| 207P00000X | Pathology | Pathologists who oversee laboratory testing, quality control, and interpretation |
| 208000000X | Family Medicine | Primary care and urgent care clinicians who order 86625 for symptomatic patients |
| 207L00000X | Microbiology | Clinical laboratory scientists/medical technologists performing immunoassays |
| 261QM0800X | Laboratory Director | Clinical laboratory directors responsible for test validation and billing notes |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A04.5 | Campylobacter enteritis | Primary diagnosis indicating Campylobacter infection; direct indication for 86625 serology as adjunctive testing |
A09 | Infectious gastroenteritis and colitis, unspecified | Symptom-based diagnosis when specific pathogen not yet identified; serology can help identify Campylobacter |
R19.7 | Diarrhea, unspecified | Symptom code used when evaluating causes of diarrhea; serologic testing may support diagnosis when stool tests are negative |
E86.0 | Dehydration | Common complication of acute enteritis; labs including serology may be performed during assessment of dehydrated patients |
A04.2 | Enteritis due to Escherichia coli | Other bacterial enteritis codes commonly considered in differential diagnosis during testing for enteric pathogens |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87045 | Culture, bacterial; stool, with isolation of pathogen (e.g., Campylobacter) | Stool culture is a primary diagnostic test for Campylobacter and often performed before or alongside serology to identify organism directly |
87798 | Infectious agent antigen detection by immunoassay, multiple-step method, qualitative or semiquantitative; not otherwise classified | Alternative rapid antigen tests for enteric pathogens that may be ordered as part of infectious diarrhea workup |
87449 | Infectious agent detection by nucleic acid (DNA or RNA), PCR, Campylobacter (example code range) | Molecular testing (PCR) on stool provides direct sensitive detection of Campylobacter and is commonly ordered with or instead of serology |
82653 | Antibody; Helicobacter pylori, IgG | Example of infectious serology testing methodology; illustrates laboratory workflow similar to 86625 though for a different organism |
80053 | Comprehensive metabolic panel | Routine labs obtained in patients with dehydration or systemic illness; often ordered during evaluation of suspected enteritis |