How To Use CPT Code 84703

CPT 84703 is a lab test code for detecting the presence of human chorionic gonadotropin (hCG) hormone, typically in patient blood. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 84703.

1. What is CPT 84703?

CPT 84703 is a code used by medical professionals to bill for a laboratory test that detects the presence of human chorionic gonadotropin (hCG) hormone in a patient’s blood. This test is commonly used to diagnose pregnancy, ectopic pregnancy, and hCG tumors, as well as a screening procedure before proceeding with other medical care such as sterilization.

2. 84703 CPT code description

The official description of CPT code 84703 is: Gonadotropin, chorionic (hCG); qualitative.

3. Procedure

The procedure for CPT 84703 involves the following steps:

  1. The lab analyst collects a blood specimen from the patient.
  2. The specimen is mixed with specific substances to detect the presence of human chorionic gonadotropin hormone.
  3. The test may use methods such as electrochemiluminescence immunoassay (ECLIA), which combines a sandwich antigen antibody reaction with two hCG-specific monoclonal antibodies.
  4. The lab analyst interprets the results to determine the presence or absence of hCG hormone in the patient’s blood.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 84703 services include those who:

  • Are suspected of being pregnant or experiencing an ectopic pregnancy.
  • Require screening for hCG tumors.
  • Need a screening procedure before undergoing other medical care such as sterilization.

5. When to use CPT code 84703

It is appropriate to bill the 84703 CPT code when a healthcare provider orders a test to evaluate a patient for the presence of hCG hormone, which provides an early diagnosis of pregnancy, or to screen for Down syndrome. This code can also be used for patients who require screening for hCG tumors or need a screening procedure before undergoing other medical care such as sterilization.

6. Documentation requirements

To support a claim for CPT 84703, the following information needs to be documented:

  • Patient’s medical history and presenting symptoms that justify the need for the test.
  • Physician’s order for the hCG test.
  • Details of the blood specimen collection, including date and time.
  • Method used for the hCG test (e.g., ECLIA).
  • Results of the test, including the presence or absence of hCG hormone in the patient’s blood.
  • Interpretation of the test results by the lab analyst or healthcare provider.

7. Billing guidelines

When billing for CPT code 84703, keep in mind the following guidelines and rules:

  • Organ or disease-oriented panels represent lab tests only; code the specimen collections separately using a code such as 36415.
  • Chorionic gonadotropin can be included in a laboratory panel; see codes 80414 and 80415.
  • Do not append modifier 52 to the panel code to represent reduced services.

8. Historical information

CPT 84703 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates since its addition.

9. Similar codes to CPT 84703

Five similar codes to CPT 84703 and how they differentiate from CPT 84703 are:

  • CPT 84702: This code is for a quantitative hCG test, which measures the amount of hCG hormone in the patient’s blood, rather than just detecting its presence.
  • CPT 81025: This code is for a urine pregnancy test by visual color comparison, not a blood test.
  • CPT 80414: This code represents a panel test for chorionic gonadotropin, which includes multiple tests related to hCG hormone detection.
  • CPT 80415: This code is another panel test for chorionic gonadotropin, with a different set of tests included in the panel.
  • CPT 36415: This code is for the collection of a blood specimen, which is billed separately from the lab test itself.

10. Examples

Here are 10 detailed examples of CPT code 84703 procedures:

  1. A woman experiencing early pregnancy symptoms, such as missed periods and morning sickness, undergoes an hCG test to confirm pregnancy.
  2. A patient with a history of ectopic pregnancies has an hCG test to rule out another ectopic pregnancy.
  3. A woman planning to undergo sterilization has an hCG test to ensure she is not pregnant before the procedure.
  4. A patient with a family history of Down syndrome undergoes an hCG test as part of prenatal screening.
  5. A man with suspected hCG-producing tumors has an hCG test to aid in diagnosis.
  6. A woman with irregular menstrual cycles undergoes an hCG test to determine if she is pregnant.
  7. A patient experiencing abdominal pain and vaginal bleeding has an hCG test to rule out ectopic pregnancy.
  8. A woman undergoing fertility treatments has an hCG test to confirm successful implantation of an embryo.
  9. A patient with a history of miscarriages undergoes an hCG test to monitor the progress of her pregnancy.
  10. A woman with a suspected molar pregnancy has an hCG test to aid in diagnosis.

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