How To Use CPT Code 80168

CPT code 80168 describes the analysis of ethosuximide, an anticonvulsant medication, in a patient’s specimen. 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 80168?

CPT 80168 can be used to describe the analysis of ethosuximide, an anticonvulsant medication, in a patient’s specimen. This code is used when a lab analyst performs the technical steps to measure the level of ethosuximide present in the specimen, most commonly serum. The test may involve various steps, such as reacting the specimen with test antibodies, incubating the mixture, adding an agent to detect the antigen-antibody complex, and quantifying the result.

2. Official Description

The official description of CPT code 80168 is: ‘Ethosuximide; therapeutic drug assay.’

3. Procedure

1. The lab analyst performs the technical lab test to analyze a specimen, usually serum, to quantitate the amount of ethosuximide present.
2. The test may involve various steps, such as reacting the specimen with test antibodies, incubating the mixture, adding an agent to detect the antigen-antibody complex, and quantifying the result.
3. The lab analyst may use an immunoassay method, such as enzyme-linked immunosorbent assay (ELISA), to detect the presence of ethosuximide.

4. Qualifying circumstances

CPT 80168 is typically ordered by clinicians for young children suffering from petit mal seizures who are on the drug ethosuximide. The test helps ensure that the clinician is prescribing the correct dose of the medication. However, the test is not limited to a specific condition and can be ordered for other patients as well.

5. When to use CPT code 80168

CPT code 80168 should be used when a lab analyst performs the analysis of ethosuximide in a patient’s specimen, typically serum. It is important to ensure that the test is medically necessary and ordered by a clinician for the appropriate patient population.

6. Documentation requirements

To support a claim for CPT 80168, the documentation should include:

• Indication of why the test was ordered, such as the patient’s condition or medication regimen
• Details of the specimen analyzed, including the type (e.g., serum) and any specific preparation or handling instructions
• Description of the test method used, such as immunoassay or ELISA
• Quantitative results of the analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 80168, ensure that the test is performed by a lab analyst and that the necessary documentation is provided. It is important to follow the specific guidelines and requirements of the payer. Some payers may also separately reimburse for the collection of the specimen using a code such as 36415.

8. Historical information

CPT 80168 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the analysis of ethosuximide in a patient’s serum specimen to ensure the correct dosage for a young child with petit mal seizures.
2. A clinician orders the analysis of ethosuximide in a patient’s specimen to monitor the drug levels and adjust the dosage accordingly.
3. A lab analyst uses an immunoassay method to detect the presence of ethosuximide in a patient’s serum specimen.
4. A clinician orders the analysis of ethosuximide in a patient’s specimen to confirm compliance with the prescribed medication regimen.
5. A lab analyst quantifies the amount of ethosuximide present in a patient’s serum specimen using a specific test method.
6. A clinician orders the analysis of ethosuximide in a patient’s specimen to assess the effectiveness of the medication in controlling seizures.
7. A lab analyst performs the analysis of ethosuximide in a patient’s serum specimen as part of routine therapeutic drug monitoring.
8. A clinician orders the analysis of ethosuximide in a patient’s specimen to evaluate potential drug interactions.
9. A lab analyst uses an immunoassay method to detect the presence of ethosuximide in a patient’s serum specimen for therapeutic drug monitoring.
10. A clinician orders the analysis of ethosuximide in a patient’s specimen to ensure the medication is within the therapeutic range.