How To Use CPT Code 3455F

CPT 3455F refers to the screening for tuberculosis (TB) performed and interpreted within six months prior to the initiation of first-time biologic disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis (RA). This screening is crucial as patients with RA who are starting these therapies are at an increased risk for reactivation of latent TB infections. The procedure involves conducting a TB test, typically a skin test, to ensure that the patient does not have an active TB infection before commencing treatment that could exacerbate their condition.

1. What is CPT code 3455F?

CPT code 3455F represents a specific quality measure related to the management of patients with rheumatoid arthritis who are about to begin biologic disease-modifying anti-rheumatic drug therapy. The purpose of this code is to ensure that healthcare providers conduct a TB screening test within a defined timeframe—specifically, within six months prior to starting the therapy. This is particularly important because patients with RA are at a higher risk for reactivating latent tuberculosis infections due to the immunosuppressive effects of the medications used to treat their condition. The screening process helps to identify any latent TB infections that could potentially become active and lead to serious health complications if not addressed before starting the therapy.

2. Qualifying Circumstances

This CPT code can be used when a healthcare provider screens a patient for tuberculosis prior to initiating first-time biologic disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis. The screening must be performed within six months of starting the therapy. It is essential that the provider documents the date of the TB test in the patient’s medical record to comply with this measure. The use of this code is appropriate in clinical situations where a patient with rheumatoid arthritis is being considered for biologic therapy, and it is inappropriate if the screening is not conducted within the specified timeframe or if the patient has already been treated for active TB.

3. When To Use CPT 3455F

CPT code 3455F is utilized when a healthcare provider performs a TB screening test on a patient with rheumatoid arthritis who is about to begin first-time biologic disease-modifying anti-rheumatic drug therapy. The screening must occur within six months prior to the initiation of the therapy. It is important to note that this code should not be used if the patient has already been diagnosed with active tuberculosis or if the screening was conducted outside the six-month window. Additionally, this code is not applicable if the patient has previously undergone TB screening that meets the criteria but is not documented in the medical record.

4. Official Description of CPT 3455F

Official Descriptor: TB screening performed and results interpreted within six months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy for RA (RA).

5. Clinical Application

CPT 3455F is applied in the clinical context of managing rheumatoid arthritis patients who are candidates for biologic disease-modifying anti-rheumatic drug therapy. The importance of this screening lies in the potential risk of reactivating latent tuberculosis infections when patients are treated with immunosuppressive therapies. By conducting this screening, healthcare providers can identify and manage any latent TB infections before they escalate into active disease, thereby safeguarding the patient’s health and ensuring the efficacy of the RA treatment plan.

5.1 Provider Responsibilities

The provider’s responsibilities during this process include conducting the TB screening test, which is typically a skin test, and interpreting the results. The provider must ensure that the screening is performed within the appropriate timeframe—specifically, within six months prior to the initiation of the biologic therapy. After administering the test, the provider must carefully evaluate the results and document the date of the test in the patient’s medical record, ensuring that all necessary information is accurately recorded for future reference.

5.2 Unique Challenges

One of the unique challenges associated with this service is the need for timely screening and interpretation of results. Delays in conducting the TB test or interpreting the results can lead to postponements in starting the necessary RA treatment, which may negatively impact the patient’s condition. Additionally, providers must be vigilant in identifying patients who may have a higher risk of latent TB reactivation, requiring thorough patient history assessments and follow-up care to ensure patient safety.

5.3 Pre-Procedure Preparations

Before performing the TB screening, the provider must evaluate the patient’s medical history, including any previous TB infections or treatments. It is also essential to assess the patient’s risk factors for TB exposure, such as travel history or contact with individuals diagnosed with active TB. Proper preparation ensures that the provider can make informed decisions regarding the necessity and urgency of the TB screening.

5.4 Post-Procedure Considerations

After the TB screening is conducted, the provider must monitor the patient for any adverse reactions to the test, particularly if a skin test is used. Follow-up appointments may be necessary to discuss the results and determine the next steps in the treatment plan. If the screening indicates a latent TB infection, the provider must initiate appropriate treatment before proceeding with the biologic therapy for rheumatoid arthritis.

6. Relevant Terminology

Rheumatoid Arthritis (RA): A chronic inflammatory disorder that primarily affects joints, leading to pain, swelling, and potential joint damage.

Biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs): A class of medications used to treat rheumatoid arthritis by targeting specific components of the immune system to reduce inflammation and prevent joint damage.

Latent Tuberculosis Infection: A condition in which a person is infected with the tuberculosis bacteria but does not exhibit active symptoms or disease. It can potentially reactivate if the immune system is compromised.

TB Screening Test: A diagnostic test, often a skin test, used to determine if a person has been infected with the tuberculosis bacteria.

7. Clinical Examples

1. A 45-year-old female with a long-standing history of rheumatoid arthritis is scheduled to start a new biologic therapy. Her provider conducts a TB screening test to ensure her safety before treatment.

2. A 60-year-old male patient with rheumatoid arthritis presents for his first biologic therapy appointment. The provider reviews his medical history and performs a TB test within the required timeframe.

3. A patient with rheumatoid arthritis who recently traveled to a high TB prevalence area is screened for TB before starting new medication.

4. A 50-year-old woman with a history of latent TB is monitored closely by her provider, who performs the TB screening test before initiating biologic therapy.

5. A healthcare provider documents the date of a TB screening test in a patient’s medical record to comply with quality measures before starting RA treatment.

6. A patient with rheumatoid arthritis experiences a delay in starting biologic therapy due to an unperformed TB screening test, highlighting the importance of timely testing.

7. A provider interprets the results of a TB screening test and finds no signs of active infection, allowing the patient to proceed with biologic therapy.

8. A patient with rheumatoid arthritis is informed about the importance of TB screening before starting treatment and agrees to undergo the test.

9. A healthcare team discusses the implications of a positive TB screening test and the necessary steps to manage the patient’s care before starting RA therapy.

10. A provider reviews a patient’s previous TB screening results and determines that a new test is required before initiating biologic therapy for rheumatoid arthritis.