How To Use CPT Code 80167

CPT 80167 describes the laboratory test used to measure the level of felbamate in a patient’s specimen, such as serum. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 80167?

CPT 80167 can be used to describe the laboratory test performed by a lab analyst to quantify the level of felbamate in a patient’s specimen, typically serum or plasma. Felbamate is an anticonvulsant drug used to treat certain seizure disorders. This code is used when the lab analyst performs all the technical steps to measure the level of felbamate present in the specimen using a detection method such as liquid chromatography-tandem mass spectrometry (LC-MS/MS).

2. Official Description

The official description of CPT code 80167 is: ‘Therapeutic drug assay(s), quantitative; not elsewhere specified.’

3. Procedure

1. The lab analyst performs all the technical steps to measure the level of felbamate present in the patient’s specimen, typically serum or plasma.
2. The most common detection method used is liquid chromatography-tandem mass spectrometry (LC-MS/MS).
3. The specimen is prepared for an automated analytical instrument, which separates the components through a high-pressure liquid chromatograph and quantifies the individual components in a mass spectrometer based on mass to charge ratio.
4. The instrument provides a quantitative result for felbamate and any measured metabolites, if performed.

4. Qualifying circumstances

CPT 80167 is typically ordered by clinicians for patients who are prescribed felbamate to treat conditions such as partial seizures. The test is used to evaluate therapeutic levels, patient compliance, and concentration changes due to interactions with other prescribed drugs, such as barbiturates. It is not limited to testing for a specific condition but is commonly used in the context of felbamate therapy.

5. When to use CPT code 80167

CPT code 80167 should be used when a quantitative test is performed to measure the level of felbamate in the patient’s specimen, such as serum. It is important to note that this code is not used for therapeutic drug monitoring of felbamate levels, but rather for measuring the concentration of felbamate in the specimen.

6. Documentation requirements

To support a claim for CPT 80167, the documentation should include:

• Indication for the test, such as the patient being prescribed felbamate for the treatment of partial seizures
• Type of specimen collected, such as serum or plasma
• Date and time of specimen collection
• Method used for the test, such as liquid chromatography-tandem mass spectrometry (LC-MS/MS)
• Quantitative result for felbamate and any measured metabolites, if performed

7. Billing guidelines

When billing for CPT 80167, ensure that the test is performed to measure the level of felbamate in the patient’s specimen. It is important to note that some payers may separately reimburse for the collection of the specimen using a code such as 36415. Additionally, CPT 80167 should not be reported with other codes for therapeutic drug monitoring of felbamate levels. It is also worth mentioning that CPT 80339 is available for a definitive drug test for antiepileptics, including felbamate, for a different clinical purpose than therapeutic drug monitoring.

8. Historical information

CPT 80167 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a quantitative test to measure the level of felbamate in a patient’s serum specimen to evaluate therapeutic levels and patient compliance.
2. A clinician orders a quantitative test for felbamate in a patient’s plasma specimen to assess concentration changes due to interactions with other prescribed drugs.
3. A lab technician uses liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure the level of felbamate in a patient’s serum specimen for therapeutic drug monitoring purposes.
4. A physician requests a quantitative test for felbamate in a patient’s plasma specimen to ensure appropriate dosing and efficacy of the anticonvulsant medication.
5. A healthcare provider orders a quantitative test for felbamate in a patient’s serum specimen to monitor the concentration of the drug during the course of treatment.
6. A lab analyst performs a quantitative test to measure the level of felbamate in a patient’s plasma specimen to assess the patient’s compliance with the prescribed medication.
7. A clinician orders a quantitative test for felbamate in a patient’s serum specimen to evaluate the therapeutic levels of the anticonvulsant drug.
8. A lab technician uses liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure the level of felbamate in a patient’s plasma specimen to ensure optimal drug concentration for seizure control.
9. A physician requests a quantitative test for felbamate in a patient’s serum specimen to monitor the drug levels and adjust the dosage if necessary.
10. A healthcare provider orders a quantitative test for felbamate in a patient’s plasma specimen to assess the drug’s concentration and potential interactions with other medications.