How To Use CPT Code 84030

CPT 84030 describes the measurement of the amino acid phenylalanine in the blood, which is commonly used to diagnose and monitor phenylketonuria (PKU). 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 84030?

CPT 84030 is used to measure the amount of phenylalanine, an amino acid, in the blood. This test is commonly performed to diagnose and monitor phenylketonuria (PKU), a rare genetic defect that causes abnormal buildup of phenylalanine in the body. The test is typically done using a blood sample collected on a filter paper blood spot card or from blood plasma.

2. Official Description

The official description of CPT code 84030 is: ‘Phenylalanine (PKU), blood.’

3. Procedure

1. The lab analyst collects a blood sample, either on a filter paper blood spot card or from blood plasma.
2. The lab analyst performs the technical steps to quantitate the amount of phenylalanine in the sample.
3. The most common method used is liquid chromatography with tandem mass spectrometry, which involves bombarding the sample with electrons and then analyzing the resulting fragmentation pattern to identify and measure the phenylalanine.
4. The lab analyst records the results of the test.

4. Qualifying circumstances

CPT 84030 is typically used for patients suspected of having phenylketonuria (PKU) or those who are already under treatment for PKU and require monitoring of their phenylalanine levels. The test is ordered by clinicians to determine the presence and amount of phenylalanine in the blood, which helps in the diagnosis and management of PKU.

5. When to use CPT code 84030

CPT code 84030 should be used when measuring the amount of phenylalanine in the blood, specifically for the diagnosis and monitoring of phenylketonuria (PKU). It is important to use this code when the test is performed to ensure accurate billing and documentation.

6. Documentation requirements

To support a claim for CPT 84030, the following documentation is typically required:

• Indication for the test, such as suspicion of PKU or monitoring of PKU treatment
• Type of sample collected (blood spot card or blood plasma)
• Date and time of the test
• Results of the test, including the measured amount of phenylalanine
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 84030, ensure that the test is performed to measure phenylalanine levels in the blood. It is important to use the appropriate diagnosis code to support medical necessity. Additionally, payers may have specific requirements for documentation and billing, so it is important to familiarize yourself with their guidelines.

8. Historical information

CPT 84030 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A newborn screening test performed on a blood spot card to detect phenylketonuria (PKU) in an infant.
2. A follow-up test on a blood plasma sample to monitor the phenylalanine levels of a patient with PKU who is undergoing treatment.
3. A diagnostic test on a blood sample to confirm the presence of phenylketonuria (PKU) in a child with developmental delays.
4. A routine monitoring test on a blood spot card to assess the phenylalanine levels of a patient with PKU who is on a strict diet.
5. A confirmatory test on a blood plasma sample to rule out phenylketonuria (PKU) in a newborn with an abnormal newborn screening result.
6. A test on a blood sample to evaluate the effectiveness of dietary modifications in managing phenylketonuria (PKU) in an adult patient.
7. A test on a blood spot card to screen for phenylketonuria (PKU) in a pregnant woman.
8. A monitoring test on a blood plasma sample to assess the phenylalanine levels of a patient with PKU during pregnancy.
9. A diagnostic test on a blood sample to investigate the cause of intellectual disability in a child.
10. A follow-up test on a blood spot card to monitor the phenylalanine levels of a patient with PKU who has recently started a new treatment regimen.