How To Use CPT Code 80197

CPT code 80197 describes the laboratory test used to quantitate the total amount of tacrolimus, an immunosuppressant drug, 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 80197?

CPT 80197 can be used to describe the laboratory test performed by a lab analyst to measure the level of tacrolimus present in a patient’s specimen. This test is commonly ordered for patients taking tacrolimus following a transplant to ensure they are receiving the correct dose of the medication.

2. Official Description

The official description of CPT code 80197 is: ‘Therapeutic drug assay(s), immunosuppressive agent(s), not elsewhere specified; tacrolimus.’

3. Procedure

1. The lab analyst performs the technical steps to analyze the patient’s specimen and measure the level of tacrolimus present.
2. The most common specimen used for this test is serum, which is obtained by the collecting provider as a separate procedure.
3. The lab analyst uses liquid chromatography or mass spectrometry as the method of detection to quantify the components in the specimen.
4. If using liquid chromatography, the analyst mixes the specimen with a reagent and passes the mixture through a solid material under pressure. This process separates out specific components in the specimen, which are then quantified.
5. If using mass spectrometry, the analyst bombards the atoms or molecules from the sample with electrons and applies an electric or magnetic field. The resulting elements or molecules are identified by their masses or characteristic fragmentation pattern.

4. Qualifying circumstances

CPT 80197 is not limited to testing for a specific condition but is commonly ordered for patients taking tacrolimus following a transplant. The test is performed by a lab analyst to measure the level of tacrolimus present in the patient’s specimen, typically serum.

5. When to use CPT code 80197

CPT code 80197 should be used when a lab analyst performs a therapeutic drug assay to measure the level of tacrolimus in a patient’s specimen. This test is commonly ordered for patients taking tacrolimus following a transplant to ensure they are receiving the appropriate dose of the medication.

6. Documentation requirements

To support a claim for CPT 80197, the following documentation is required:

• Patient’s diagnosis or indication for the test
• Type of specimen collected (e.g., serum)
• Date and time of specimen collection
• Method of detection used (e.g., liquid chromatography or mass spectrometry)
• Results of the test, including the quantitated level of tacrolimus
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 80197, ensure that the test is performed by a lab analyst and that the appropriate documentation is provided. It is important to note that some payers may separately reimburse for the collection of the specimen using a different code, such as 36415 for venous blood collection by venipuncture.

8. Historical information

CPT 80197 was added to the Current Procedural Terminology system on January 1, 1997. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a therapeutic drug assay to measure the level of tacrolimus in a patient’s serum specimen following a kidney transplant.
2. A patient who has received a liver transplant undergoes a therapeutic drug assay to ensure they are receiving the appropriate dose of tacrolimus.
3. A lab analyst uses liquid chromatography to quantify the level of tacrolimus in a patient’s serum specimen following a heart transplant.
4. A patient taking tacrolimus following a lung transplant undergoes a therapeutic drug assay to monitor the level of the medication in their system.
5. A lab analyst performs a mass spectrometry-based therapeutic drug assay to measure the level of tacrolimus in a patient’s serum specimen following a pancreas transplant.
6. A patient who has received a bone marrow transplant undergoes a therapeutic drug assay to ensure they are receiving the correct dose of tacrolimus.
7. A lab analyst uses liquid chromatography to quantify the level of tacrolimus in a patient’s serum specimen following a heart-lung transplant.
8. A patient taking tacrolimus following a kidney-pancreas transplant undergoes a therapeutic drug assay to monitor the level of the medication in their system.
9. A lab analyst performs a mass spectrometry-based therapeutic drug assay to measure the level of tacrolimus in a patient’s serum specimen following a liver-kidney transplant.
10. A patient who has received a heart transplant undergoes a therapeutic drug assay to ensure they are receiving the appropriate dose of tacrolimus.