CPT® Code 86235 is used to report extractable nuclear antigen (ENA) antibody testing, performed by any laboratory method. ENA antibodies target specific nuclear proteins and are commonly used to evaluate and differentiate autoimmune and connective tissue diseases, particularly when an antinuclear antibody (ANA) test is positive.
ENA testing helps providers identify specific autoantibodies associated with conditions such as systemic lupus erythematosus (SLE), Sjögren’s syndrome, mixed connective tissue disease, scleroderma, and inflammatory myopathies.
CPT 86235 represents the laboratory test itself. Interpretation, diagnosis, or treatment planning is billed separately.
Key Facts About CPT® 86235
- Service type: Clinical laboratory immunology test
- Provider type: Physicians, laboratories, and qualified healthcare professionals
- Medical services included: Detection of extractable nuclear antigen antibodies (any method)
- Specimen type: Blood (serum)
- Common clinical indications:
- Evaluation of suspected autoimmune or connective tissue disease
- Follow-up testing after a positive ANA result
- Differentiation between autoimmune conditions
- Monitoring disease activity in certain autoimmune disorders
- Investigation of unexplained systemic or inflammatory symptoms
When to Use CPT® 86235
CPT 86235 is appropriate when:
- A blood sample is collected to assess ENA antibody presence
- Autoimmune disease is suspected based on symptoms or prior lab findings
- Results will influence diagnosis, differential evaluation, or treatment decisions
Examples:
- Confirmatory testing following a positive ANA screen
- Evaluating sicca symptoms suggestive of Sjögren’s syndrome
- Investigating connective tissue disease in patients with systemic inflammation
- Differentiating lupus from other autoimmune conditions
Documentation Requirements
To properly support CPT 86235 billing, documentation should include:
- Patient identifiers and date of specimen collection
- Ordering provider and clinical indication for ENA testing
- Confirmation that an ENA antibody test was performed
- Test methodology (if required by payer) and results
- Clinical follow-up, diagnosis, or care plan adjustments
Complete documentation supports medical necessity, audit readiness, and continuity of autoimmune care.
Reimbursement and Coding Considerations
- CPT 86235 is typically covered by Medicare and commercial insurers when medically necessary
- Coverage often requires supporting diagnoses related to autoimmune or connective tissue disease
- Interpretation and management services are not included and billed separately
- Frequency limits or prior authorization may apply depending on payer policies
- Always confirm payer-specific rules regarding autoimmune antibody testing
How OptiMantra Supports Autoimmune and Specialty Lab Testing
OptiMantra’s integrated EMR and practice management platform is well suited for managing complex lab testing such as CPT 86235 in integrative and specialty practices.
With OptiMantra, providers can:
- Order ENA antibody testing directly within the patient chart
- Track autoimmune lab results longitudinally alongside ANA and inflammatory markers
- Link lab findings to diagnoses, symptoms, and treatment plans
- Maintain audit-ready documentation for compliant billing
- Integrate lab insights into comprehensive, whole-person care strategies
By centralizing lab data, documentation, and billing workflows, OptiMantra supports accurate autoimmune evaluation and long-term condition management.
Try OptiMantra for free here!
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