How To Use CPT Code 84403

CPT 84403 is a code used for measuring total testosterone levels in a patient’s serum. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 84403.

1. What is CPT 84403?

CPT 84403 is a code used by medical professionals to bill for the laboratory test that measures the total testosterone levels in a patient’s serum. This test is essential for evaluating various conditions related to hormonal imbalances, such as low sex drive, infertility, and abnormal physical traits.

2. 84403 CPT code description

The official description of CPT code 84403 is: Testosterone; total.

3. Procedure

The procedure for CPT 84403 involves the following steps:

  1. Collection of the patient’s blood sample, typically through venipuncture.
  2. Separation of the serum from the blood sample.
  3. Preparation of the serum sample by mixing it with specific substances.
  4. Measurement of total testosterone levels, which includes both the portion bound to proteins and the active unbound, or free, portion.
  5. Analysis of the results using methods such as chromatography, which separates and analyzes the amount of a specific analyte in a chemical mixture carried by liquid or gas.
  6. Interpretation of the results by a medical professional to evaluate the patient’s condition and determine the appropriate course of action.

4. Qualifying circumstances

Patients eligible to receive CPT code 84403 services are those who require evaluation for conditions related to hormonal imbalances. These conditions may include:

  • Low sex drive
  • Infertility
  • Premature or delayed puberty
  • Some types of tumors
  • Testosterone replacement therapy
  • Menstrual cycle absence or irregularity
  • Ovarian cysts
  • Abnormal physical traits such as hirsutism

5. When to use CPT code 84403

It is appropriate to bill the 84403 CPT code when a medical professional orders a total testosterone test to evaluate a patient for any of the conditions mentioned in the qualifying circumstances section. The test may be ordered alone or in conjunction with other tests, such as CPT 84402 (Testosterone; free).

6. Documentation requirements

To support a claim for CPT 84403, the following information needs to be documented:

  • Patient’s demographic information, including name, date of birth, and gender.
  • Medical history and presenting symptoms related to hormonal imbalances.
  • Physical examination findings, if applicable.
  • Indication for the total testosterone test, including the specific condition being evaluated.
  • Order for the total testosterone test, signed by the ordering medical professional.
  • Results of the total testosterone test, including the method used for analysis.
  • Interpretation of the results and any subsequent treatment plan or recommendations.

7. Billing guidelines

When billing for CPT code 84403, it is essential to follow the specific guidelines and rules set by the payer. Some payers may pay separately for collecting the specimen using a code such as CPT 36415 (Collection of venous blood by venipuncture). Additionally, ensure that all documentation requirements are met to support the claim for CPT 84403.

8. Historical information

CPT 84403 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 84403

Five similar codes to CPT 84403 and how they differentiate are:

  • CPT 84402: This code is used for measuring free testosterone levels, which is the active unbound portion of testosterone.
  • CPT 84439: This code is used for measuring total thyroxine (T4) levels, a hormone produced by the thyroid gland.
  • CPT 84443: This code is used for measuring thyroid-stimulating hormone (TSH) levels, which regulate the production of thyroid hormones.
  • CPT 84479: This code is used for measuring unbound (free) triiodothyronine (T3) levels, another hormone produced by the thyroid gland.
  • CPT 84144: This code is used for measuring total progesterone levels, a hormone produced by the ovaries and adrenal glands in women and the testicles and adrenal glands in men.

10. Examples

Here are 10 detailed examples of CPT code 84403 procedures:

  1. A 35-year-old male patient with low sex drive and fatigue undergoes a total testosterone test to evaluate his hormone levels.
  2. A 28-year-old female patient with irregular menstrual cycles and hirsutism undergoes a total testosterone test to assess her hormone levels.
  3. A 16-year-old male patient with delayed puberty undergoes a total testosterone test to determine if hormonal imbalances are causing his delayed development.
  4. A 40-year-old male patient undergoing testosterone replacement therapy has a total testosterone test to monitor his hormone levels and adjust his treatment plan accordingly.
  5. A 30-year-old female patient with infertility undergoes a total testosterone test as part of her fertility evaluation.
  6. A 45-year-old male patient with a suspected testosterone-producing tumor undergoes a total testosterone test to confirm the diagnosis.
  7. A 25-year-old female patient with polycystic ovary syndrome (PCOS) undergoes a total testosterone test to evaluate her hormone levels and guide her treatment plan.
  8. A 50-year-old male patient with erectile dysfunction undergoes a total testosterone test to determine if low testosterone levels are contributing to his condition.
  9. A 38-year-old female patient with amenorrhea (absence of menstruation) undergoes a total testosterone test to evaluate her hormone levels and identify the cause of her condition.
  10. A 21-year-old male patient with gynecomastia (enlarged breast tissue in males) undergoes a total testosterone test to assess his hormone levels and determine the cause of his condition.

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