CPT® Code 86618 is used to report antibody testing for Borrelia burgdorferi, the bacterium that causes Lyme disease. The test evaluates a patient's immune response to the organism and may be used when Lyme disease is suspected based on symptoms, exposure history, or other clinical findings.
Lyme disease serology is commonly performed as part of a two-step testing approach, with an initial antibody test followed by additional testing when indicated under current laboratory and clinical guidelines.
This code represents the laboratory antibody assay and does not include separate specimen collection or evaluation and management services.
Key Facts About CPT® 86618
- Service type: Laboratory immunology test
- Test: Borrelia burgdorferi antibody
- Specimen type: Typically serum
- Test purpose: Evaluate evidence of immune response to the organism that causes Lyme disease
- Provider type: Physicians, laboratories, and qualified healthcare professionals
Common clinical indications:
- Suspected Lyme disease
- History of potential tick exposure
- Erythema migrans or other compatible clinical findings
- Neurologic symptoms potentially associated with Lyme disease
- Musculoskeletal symptoms associated with suspected Lyme disease
- Follow-up evaluation when clinically appropriate
When to Use CPT® 86618
CPT 86618 may be appropriate when:
- A provider orders antibody testing for Borrelia burgdorferi
- The patient's symptoms and clinical history support evaluation for Lyme disease
- There is a relevant history of possible tick exposure
- Serologic testing is clinically appropriate based on the suspected stage and presentation of disease
Examples:
- Evaluating a patient with compatible symptoms after potential tick exposure
- Investigating neurologic symptoms when Lyme disease is part of the differential diagnosis
- Evaluating joint symptoms when Lyme arthritis is suspected
- Performing appropriate serologic evaluation based on a patient's exposure and clinical presentation
Laboratory testing should be interpreted alongside the patient's clinical presentation because antibody testing may not be appropriate in every suspected case.
Documentation Requirements
To support CPT 86618 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for Lyme disease testing
- Relevant symptoms and physical findings
- Tick exposure or geographic/travel history when clinically relevant
- Suspected or documented diagnosis
- Specific antibody testing performed
- Test result and date reported
- Ordering provider information
Clear documentation helps establish medical necessity and supports appropriate interpretation and follow-up of laboratory findings.
Reimbursement and Coding Considerations
- CPT 86618 reports antibody testing for Borrelia burgdorferi
- Lyme disease serology may be performed as part of a recommended two-tier or modified two-tier diagnostic approach
- Diagnosis coding should support suspected infection, relevant symptoms, exposure, or another medically necessary indication
- Testing should be ordered based on appropriate clinical criteria because false-positive and false-negative results can occur
- Coverage and testing requirements vary by payer and clinical circumstances
- Specimen collection may be separately reportable when permitted by payer policy
Always verify current laboratory guidelines, CPT requirements, and payer-specific coverage policies before submitting claims.
How OptiMantra Supports Lyme Disease Testing
OptiMantra's integrated EMR and practice management platform helps streamline documentation and billing for CPT 86618.
With OptiMantra, providers can:
- Order Lyme disease laboratory testing within the patient chart
- Document symptoms, exposure history, and clinical indications
- Link laboratory findings to diagnoses, treatment plans, and follow-up recommendations
- Maintain organized laboratory documentation that supports billing compliance and audit preparedness
- Keep infectious disease testing and related clinical information within the patient's longitudinal record
By centralizing laboratory workflows, OptiMantra helps practices maintain organized documentation and support coordinated patient care.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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