How To Use CPT Code 3494F

CPT 3494F refers to the measurement of CD4+ cell count in individuals diagnosed with human immunodeficiency virus (HIV). This specific code is utilized when the CD4+ cell count is documented to be less than 200 cells per millimeter cubed (cells/mm3), indicating a significant decline in immune function and a higher risk for opportunistic infections. The CD4+ cell count is a crucial marker in monitoring the progression of HIV and the overall health of the immune system in affected individuals.

1. What is CPT code 3494F?

CPT code 3494F represents the documentation of a CD4+ cell count of less than 200 cells/mm3 in patients diagnosed with HIV. This measurement is vital for assessing the immune status of individuals living with HIV, as CD4+ cells, also known as helper T cells, play a critical role in the immune response. A CD4+ count below this threshold is indicative of acquired immunodeficiency syndrome (AIDS), which signifies a severely compromised immune system. Clinically, this code is used to track the progression of HIV infection and to guide treatment decisions, particularly in the context of preventing opportunistic infections that can arise when the immune system is weakened.

2. Qualifying Circumstances

This CPT code can be used specifically when a patient with HIV has a CD4+ cell count documented to be less than 200 cells/mm3. It is essential for healthcare providers to ensure that the test is performed accurately and that the results are reported in the patient’s medical record. The use of this code is appropriate in clinical scenarios where monitoring the immune status of an HIV-positive patient is necessary, especially when evaluating the risk for opportunistic infections. Inappropriate use of this code would occur if the CD4+ count is above 200 cells/mm3 or if the patient does not have a confirmed diagnosis of HIV.

3. When To Use CPT 3494F

CPT 3494F is used when a healthcare provider documents a CD4+ cell count of less than 200 cells/mm3 in an HIV-positive patient. This code should be reported alongside other relevant codes that pertain to the patient’s overall health and treatment plan. It is important to note that this code cannot be used in conjunction with codes that indicate a higher CD4+ count, as it specifically pertains to a critical threshold that indicates a severe decline in immune function. Providers must ensure that the date of the test is also recorded in the patient’s medical documentation for quality reporting purposes.

4. Official Description of CPT 3494F

Official Descriptor: CD4+ cell count < 200 cells/mm3 (HIV)

5. Clinical Application

The clinical application of CPT 3494F is primarily in the monitoring and management of patients with HIV. A CD4+ cell count of less than 200 cells/mm3 is a significant indicator of the progression of HIV to AIDS, which necessitates immediate medical attention and intervention. This measurement helps healthcare providers assess the patient’s risk for developing opportunistic infections, which are infections that occur more frequently and are more severe in individuals with weakened immune systems. By tracking CD4+ counts, providers can make informed decisions regarding antiretroviral therapy and other preventive measures to protect the patient’s health.

5.1 Provider Responsibilities

During the procedure to measure CD4+ cell counts, the provider is responsible for collecting a blood sample from the patient, which is then sent to a laboratory for analysis. The provider must ensure that the sample is handled correctly and that the laboratory performs the test according to established protocols. Once the results are available, the provider reviews the findings, documents the CD4+ cell count in the patient’s medical record, and discusses the implications of the results with the patient. This includes explaining the significance of a low CD4+ count and the potential need for additional medical interventions.

5.2 Unique Challenges

One of the unique challenges associated with measuring CD4+ cell counts is ensuring that the test is performed accurately and that the results are interpreted correctly. Factors such as the timing of the test in relation to the patient’s treatment regimen, the presence of other infections, and the overall health status of the patient can all influence CD4+ counts. Additionally, providers must navigate the complexities of managing patients with low CD4+ counts, which may include coordinating care with specialists and addressing the psychological impact of an AIDS diagnosis.

5.3 Pre-Procedure Preparations

Before measuring CD4+ cell counts, the provider should conduct a thorough evaluation of the patient’s medical history, including any current symptoms, previous laboratory results, and treatment history. It may also be necessary to perform additional tests to assess the patient’s overall health and to rule out other conditions that could affect the immune system. Proper patient education regarding the procedure and its significance is also essential to ensure that the patient understands the importance of monitoring their CD4+ count.

5.4 Post-Procedure Considerations

After the CD4+ cell count has been measured, the provider must monitor the patient for any signs of opportunistic infections or other complications associated with low immune function. Follow-up appointments should be scheduled to discuss the results and to adjust the patient’s treatment plan as necessary. Providers should also provide ongoing support and education to help patients manage their health and adhere to their treatment regimens, as well as address any concerns related to their diagnosis.

6. Relevant Terminology

Acquired immunodeficiency syndrome (AIDS): A chronic and life-threatening condition caused by the human immunodeficiency virus (HIV), characterized by a severely weakened immune system.

CD4 cells: A type of white blood cell that has a protein called cluster of differentiation 4 (CD4) on its surface, playing a crucial role in initiating the body’s immune response to infections; also known as helper T cells.

Human immunodeficiency virus (HIV): An infection that significantly lowers the body’s immune system, primarily transmitted through sexual contact, infected blood, or from mother to child during pregnancy, childbirth, or breastfeeding.

T cells: A type of blood cell that protects the body from infections by recognizing and responding to pathogens.

Virus: An infectious agent that can only reproduce inside living cells, typically too small to be seen even with a microscope.

White blood cell (WBC): One of the three main components of blood, which helps defend the body against infectious agents and foreign materials; also known as a leukocyte.

7. Clinical Examples

1. A 35-year-old male diagnosed with HIV presents for routine monitoring. His recent lab results show a CD4+ count of 180 cells/mm3, prompting the provider to discuss the increased risk of opportunistic infections.

2. A 50-year-old female with a long history of untreated HIV has a CD4+ count of 150 cells/mm3, leading to a referral for specialized care to manage her health and prevent infections.

3. A patient with HIV who has been compliant with antiretroviral therapy shows a CD4+ count of 220 cells/mm3, indicating a need for continued monitoring but no immediate intervention.

4. A 28-year-old male with a recent HIV diagnosis has a CD4+ count of 190 cells/mm3, leading the provider to initiate treatment to improve his immune function.

5. A 45-year-old female with a CD4+ count of 170 cells/mm3 is educated about the importance of medication adherence to prevent further decline in her immune status.

6. A patient with a CD4+ count of 200 cells/mm3 is monitored closely for any signs of opportunistic infections, as they are at the threshold of AIDS.

7. A 60-year-old male with a CD4+ count of 140 cells/mm3 is hospitalized due to pneumonia, highlighting the risks associated with low CD4+ counts.

8. A 32-year-old female with a CD4+ count of 210 cells/mm3 is reassured about her immune status but is advised to maintain regular follow-ups.

9. A patient with a CD4+ count of 180 cells/mm3 is provided with resources on nutrition and lifestyle changes to support immune health.

10. A 40-year-old male with a CD4+ count of 160 cells/mm3 is referred to a specialist for further evaluation and management of his HIV treatment plan.