How To Use CPT Code 81506

CPT 81506 describes the biochemical assays of seven analytes related to endocrinology, specifically type 2 diabetes. 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 81506?

CPT 81506 is used to describe the biochemical assays of seven analytes associated with endocrinology, specifically type 2 diabetes. These analytes include glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin, and interleukin 2-receptor alpha. The test utilizes serum or plasma samples and involves an algorithmic analysis that reports a risk score for the patient.

2. Official Description

The official description of CPT code 81506 is: ‘Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score.’

3. Procedure

1. The lab analyst performs biochemical assays for the seven analytes associated with type 2 diabetes using serum or plasma samples.
2. The lab analyst then carries out an algorithmic analysis using patient data and the lab test results.
3. The algorithm produces a risk score that provides diagnostic or prognostic information about treatment options or disease outcomes.
4. The lab analyst reports the risk score to the healthcare provider.

4. Qualifying circumstances

CPT 81506 is used for patients who require testing for type 2 diabetes or are at high risk of developing the disease. The test helps identify patients who may benefit from early treatment intervention to decrease the likelihood and impact of the disease. It is important to note that CPT 81506 should not be reported in conjunction with the constituent components of the test or other specific tests for adiponectin and interleukin 2-receptor alpha.

5. When to use CPT code 81506

CPT code 81506 should be used when performing biochemical assays for the seven analytes associated with type 2 diabetes and utilizing serum or plasma samples. It is appropriate for patients who require testing for type 2 diabetes or are at high risk of developing the disease. However, it should not be reported in conjunction with the constituent components of the test or other specific tests for adiponectin and interleukin 2-receptor alpha.

6. Documentation requirements

To support a claim for CPT 81506, the healthcare provider must document the following information:

• Patient’s diagnosis or indication for testing
• Specific analytes tested (glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin, interleukin 2-receptor alpha)
• Type of sample used (serum or plasma)
• Date of the test
• Results of the biochemical assays
• Risk score generated by the algorithmic analysis

7. Billing guidelines

When billing for CPT 81506, ensure that the test includes the biochemical assays of the seven analytes associated with type 2 diabetes and utilizes serum or plasma samples. Do not report the constituent components of the test or other specific tests for adiponectin and interleukin 2-receptor alpha in addition to CPT 81506. Medicare and some other payers may not accept CPT 81506 and may require billing only the underlying test codes.

8. Historical information

CPT 81506 was added to the Current Procedural Terminology system on January 1, 2013. There was a code change on January 1, 2014, which updated the description of the test to include the specific analytes and their association with type 2 diabetes.

9. Examples

1. A patient with a family history of type 2 diabetes undergoes CPT 81506 to assess their risk of developing the disease.
2. A healthcare provider orders CPT 81506 for a patient with elevated glucose levels to determine if they have developed type 2 diabetes.
3. A patient with known type 2 diabetes undergoes CPT 81506 to monitor their disease progression and assess their risk of complications.
4. A healthcare provider uses CPT 81506 to screen a group of individuals at high risk of developing type 2 diabetes as part of a population health initiative.
5. A patient with symptoms suggestive of type 2 diabetes undergoes CPT 81506 to aid in the diagnosis of the disease.
6. A healthcare provider orders CPT 81506 for a patient with uncontrolled diabetes to assess their risk of complications and guide treatment decisions.
7. A patient with prediabetes undergoes CPT 81506 to determine their risk of progressing to type 2 diabetes and to guide preventive interventions.
8. A healthcare provider uses CPT 81506 to monitor the response to treatment in a patient with type 2 diabetes and adjust their management plan accordingly.
9. A patient with well-controlled type 2 diabetes undergoes CPT 81506 as part of their routine follow-up to assess their long-term risk of complications.
10. A healthcare provider orders CPT 81506 for a patient with gestational diabetes to assess their risk of developing type 2 diabetes after pregnancy.