How To Use CPT Code 80169

CPT 80169 describes the procedure for a therapeutic drug assay to determine the level of everolimus in a patient’s specimen. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 80169?

CPT 80169 can be used to describe the procedure for a therapeutic drug assay that measures the level of everolimus in a patient’s specimen. This test is quantitative and is often ordered to evaluate whether the immunosuppressant is present in the proper range to prevent organ rejection, such as in kidney transplant patients, or for the treatment of subependymal giant cell astrocytoma.

2. Official Description

The official description of CPT code 80169 is: ‘Therapeutic drug assay(s), quantitative; not otherwise specified.’

3. Procedure

1. A lab performs a therapeutic drug assay to determine the level of everolimus present in the patient’s specimen.
2. The examination is quantitative, meaning it measures the exact amount of everolimus in the specimen.
3. This test is often ordered to evaluate whether the immunosuppressant is present in the proper range to prevent organ rejection or for the treatment of subependymal giant cell astrocytoma.
4. The lab follows specific protocols and uses appropriate equipment to accurately measure the level of everolimus in the specimen.
5. The results of the test are reported to the ordering healthcare professional for further interpretation and decision-making.

4. Qualifying circumstances

CPT 80169 is used when a therapeutic drug assay is performed to measure the level of everolimus in a patient’s specimen. This test is typically ordered for patients who are receiving everolimus as part of their treatment, such as kidney transplant patients or those with subependymal giant cell astrocytoma. The test must be quantitative, meaning it provides an exact measurement of the drug level in the specimen.

5. When to use CPT code 80169

CPT code 80169 should be used when a therapeutic drug assay is performed to measure the level of everolimus in a patient’s specimen. This code is appropriate when the test is quantitative and not otherwise specified. It is important to ensure that the test is specifically measuring the level of everolimus and not another drug or substance.

6. Documentation requirements

To support a claim for CPT 80169, the lab performing the therapeutic drug assay must document the following information:

• Patient’s information, including name and unique identifier
• Date and time of the test
• Specific drug being tested (everolimus)
• Methodology used for the assay
• Results of the test, including the measured level of everolimus
• Signature of the laboratory personnel performing the test

7. Billing guidelines

When billing for CPT 80169, ensure that the therapeutic drug assay is performed to measure the level of everolimus in the patient’s specimen. Use the appropriate CPT code based on the specific drug being tested. It is important to follow the guidelines provided by the payer and accurately report the necessary information for reimbursement.

8. Historical information

CPT 80169 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A lab performs a therapeutic drug assay to measure the level of everolimus in a kidney transplant patient’s specimen.
2. A healthcare professional orders a therapeutic drug assay to evaluate the concentration of everolimus in a patient with subependymal giant cell astrocytoma.
3. A lab technician conducts a therapeutic drug assay to determine the level of everolimus in a specimen from a patient receiving the immunosuppressant.
4. A healthcare provider requests a therapeutic drug assay to monitor the drug level of everolimus in a patient post-kidney transplant.
5. A lab performs a therapeutic drug assay to ensure that the level of everolimus in a patient’s specimen is within the therapeutic range for preventing organ rejection.
6. A healthcare professional orders a therapeutic drug assay to assess the concentration of everolimus in a patient receiving the drug for the treatment of subependymal giant cell astrocytoma.
7. A lab technician conducts a therapeutic drug assay to measure the level of everolimus in a specimen from a patient with a kidney transplant.
8. A healthcare provider requests a therapeutic drug assay to monitor the drug level of everolimus in a patient with subependymal giant cell astrocytoma.
9. A lab performs a therapeutic drug assay to ensure that the level of everolimus in a patient’s specimen is within the therapeutic range for treating subependymal giant cell astrocytoma.
10. A healthcare professional orders a therapeutic drug assay to assess the concentration of everolimus in a patient receiving the drug post-kidney transplant.