How To Use CPT Code 80186

CPT 80186 describes the analysis of free phenytoin, 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 80186?

CPT 80186 can be used to analyze the level of free phenytoin in a patient’s specimen. Phenytoin is an anticonvulsant medication commonly used to treat epilepsy and seizure disorders. This code is used when a lab analyst performs the technical steps to measure the amount of free phenytoin present in the specimen, typically serum.

2. Official Description

The official description of CPT code 80186 is: ‘Phenytoin; free.’

3. Procedure

1. The lab analyst collects a specimen, usually serum, from the patient.
2. The analyst performs the technical steps to measure the level of free phenytoin present in the specimen.
3. Common methods of detection include immunoassay methods like enzyme-linked immunosorbent assay (ELISA) or liquid chromatography.
4. The test may involve reacting the specimen with test antibodies, incubating the mixture, adding an agent to detect the antigen-antibody complex, and quantifying the result.
5. Another method involves passing the specimen through a solid material under pressure to separate out specific components, which are then quantified.

4. Qualifying circumstances

CPT 80186 is typically ordered for patients taking phenytoin for seizures, especially those with kidney disease. In patients with kidney disorders, the free phenytoin level is a better indicator of the actual drug level and correlates more with the clinical response. However, this test is not limited to a specific condition and can be ordered by clinicians to ensure the correct dosage of phenytoin is prescribed.

5. When to use CPT code 80186

CPT code 80186 should be used when a clinician orders the analysis of free phenytoin in a patient’s specimen. It is important to note that this code is specifically for the analysis of free phenytoin and not total phenytoin. If the clinician requires testing for total phenytoin, a different code should be used.

6. Documentation requirements

To support a claim for CPT 80186, the documentation should include:

• Patient’s diagnosis and the reason for ordering the test
• Details of the specimen collected, such as serum
• Method used for the analysis, such as immunoassay or liquid chromatography
• Date and time of the analysis
• Results of the analysis, including the level of free phenytoin
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 80186, ensure that the analysis is performed by a lab analyst. It is important to note that some payers may separately reimburse for the collection of the specimen using a different code. It is recommended to review payer guidelines for specific billing requirements and modifiers, if applicable.

8. Historical information

CPT 80186 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 clinician orders the analysis of free phenytoin in a patient’s serum to ensure the correct dosage is prescribed for their epilepsy.
2. A patient with kidney disease undergoes the analysis of free phenytoin to monitor their medication levels and adjust the dosage accordingly.
3. A clinician orders the analysis of free phenytoin in a patient’s specimen to assess their response to the medication and make necessary adjustments.
4. A patient taking phenytoin for seizure control undergoes the analysis of free phenytoin to ensure therapeutic levels are maintained.
5. A clinician orders the analysis of free phenytoin in a patient’s specimen to investigate potential drug interactions or toxicity.
6. A patient with epilepsy undergoes the analysis of free phenytoin to assess their medication compliance and adjust the dosage if necessary.
7. A clinician orders the analysis of free phenytoin in a patient’s specimen to evaluate the effectiveness of the medication in controlling their seizures.
8. A patient with a history of seizures undergoes the analysis of free phenytoin to monitor their medication levels during pregnancy.
9. A clinician orders the analysis of free phenytoin in a patient’s specimen to investigate potential drug resistance or non-compliance.
10. A patient with epilepsy undergoes the analysis of free phenytoin to assess their medication levels before undergoing surgery.