Clinical Context
A 32-year-old outpatient presents to a primary care clinic for evaluation after a recent needlestick exposure at work. The patient has no known history of hepatitis B vaccination or prior hepatitis B infection. A serum sample is collected and sent to the clinical laboratory for serologic testing, including an immunoassay to detect hepatitis B core IgM antibody to evaluate for acute or recent hepatitis B virus (HBV) infection. The laboratory analyst performs 86705 on the serum specimen. Typical workflow steps include: patient encounter and order entry by the clinician, phlebotomy at the outpatient clinic or collection site, specimen labeling and transport to the clinical laboratory, accessioning, performance of the immunoassay by a medical laboratory scientist, review of quality controls and result verification by a pathologist or laboratory director, and result reporting to the ordering clinician via the electronic health record or secure messaging. Typical sites of service are outpatient clinics, hospital outpatient departments, urgent care centers, and independent clinical laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | Use when billing only the professional interpretation/oversight portion of a lab test in settings where split billing is allowed. |
| 90 | Reference (outside) laboratory | Use when the specimen is sent to a reference laboratory and the performing lab is different from the billing entity.
| 91 | Repeat clinical diagnostic laboratory test | Use when the same test is repeated on the same day to obtain subsequent results.
| 52 | Reduced services | Use when the test was partially reduced or not fully performed.
| 53 | Discontinued procedure | Use when specimen processing/test was started but discontinued for documented clinical reasons.
| 59 | Distinct procedural service | Use when bundling edits require demonstration that this test is a distinct service from other billed procedures.
| 90 | (duplicate) Reference (outside) laboratory | See above — use for reference lab scenarios.
| 91 | (duplicate) Repeat clinical diagnostic laboratory test | See above.
| QW* | CLIA-waived test (note: not in raw list) | Data not available in the input.
| TC | Technical component | Use when billing only the technical component (laboratory processing) if split billing applies.
| Taxonomy Code | Specialty | Notes |
|---|
| 364A00000X | Pathology & Laboratory Medicine | Medical laboratory scientists and pathologists oversee and interpret serologic testing. |
| 207K00000X | Family Medicine | Ordering clinicians in outpatient settings who request HBV serologies.
| 208D00000X | Internal Medicine | Primary care internists ordering and managing HBV testing and follow-up.
| 208000000X | Emergency Medicine | Emergency and urgent care clinicians who order HBV serology after exposures.
| 1835S0205X | Occupational Medicine | Providers managing workplace exposures and follow-up testing.
*Note: QW is not in the input modifier list; included here to indicate a common lab modifier type but not counted among selected modifiers.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
Z20.9 | Contact with and (suspected) exposure to unspecified communicable disease | Use when documenting an exposure (e.g., needlestick) prompting HBV testing such as 86705. |
| Z11.3 | Encounter for screening for infections with a predominantly sexual mode of transmission | Use when screening asymptomatic patients for hepatitis B after risk exposure.
| B16.9 | Acute hepatitis B without hepatic coma, unspecified | 86705 detects IgM anti-HBc consistent with acute HBV infection; relevant when acute hepatitis is suspected.
| B18.1 | Chronic viral hepatitis B without delta-agent | While 86705 targets IgM (acute), it may be part of serologic workup distinguishing acute from chronic infection.
| Z23 | Encounter for immunization | Relevant when assessing immunity status and need for hepatitis B vaccination after negative serology.
| R10.9 | Abdominal pain, unspecified | Symptom-driven testing for hepatitis B serologies when patients present with hepatic-related symptoms.
| R68.89 | Other general symptoms and signs | Non-specific presentations that may prompt broad infectious workup including HBV IgM testing.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
80061 | Lipid panel | Often ordered concurrently during routine blood testing but not specific to HBV serology; may be part of a broader chemistry panel drawn at the same visit. |
| 86704 | Hepatitis B core antibody, total (e.g., IgG and IgM) | Performed alongside or instead of 86705 to assess prior exposure and differentiate acute vs. past infection when combined with 86705 results.
| 87340 | Hepatitis B surface antigen (HBsAg) | Commonly ordered with 86705 to detect active HBV infection; combined interpretation informs acute vs. chronic infection status.
| 86804 | Hepatitis B surface antibody (anti-HBs) | Ordered to assess immunity from vaccination versus prior infection; complements 86705 and 87340 in serologic panels.
| 36415 | Collection of venous blood by venipuncture | The phlebotomy procedure used to obtain the serum specimen for 86705 testing.
| 80053 | Comprehensive metabolic panel | May be ordered in the same encounter to evaluate hepatic function and general metabolic status when liver infection is suspected.