How To Use CPT Code 84163

CPT 84163 describes the quantitation of pregnancy-associated plasma protein A (PAPP-A) through laboratory testing. 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 84163?

CPT 84163 can be used to describe the laboratory testing performed to quantitate pregnancy-associated plasma protein A (PAPP-A). This test is commonly conducted during the first trimester of pregnancy and is used to assess the risk of Down syndrome and complications of pregnancy.

2. Official Description

The official description of CPT code 84163 is: ‘Quantitation of pregnancy-associated plasma protein A (PAPP-A).’

3. Procedure

1. The lab analyst performs a test to quantitate pregnancy-associated plasma protein A (PAPP-A) in serum or plasma.
2. The test typically involves using laboratory instrumentation and reagents for enzyme-linked immunosorbent assay (ELISA) methodology.
3. During the test, antibodies, color change, and several technical steps including pretreatment, incubation, washing, and spectrometry are utilized to identify and measure the quantity of PAPP-A.

4. Qualifying circumstances

CPT 84163 is typically ordered by clinicians to evaluate pregnant patients during the first trimester. Low levels of PAPP-A at this stage may indicate a higher risk of premature delivery, miscarriage, preeclampsia, and fetal demise. The test is also commonly used to screen for fetal chromosomal aneuploidies, such as Down syndrome and Edwards syndrome. Additionally, clinicians may order the test for other reasons, such as assessing patients with certain heart conditions.

5. When to use CPT code 84163

CPT code 84163 should be used when there is a need to quantitate pregnancy-associated plasma protein A (PAPP-A) through laboratory testing. It is appropriate for assessing the risk of Down syndrome and complications of pregnancy during the first trimester. However, it is important to note that this code should not be used for testing related to specific conditions or diseases.

6. Documentation requirements

To support a claim for CPT 84163, the documentation should include:

• Indication for the test, such as assessing the risk of Down syndrome or complications of pregnancy
• Details of the laboratory testing performed, including the methodology used
• Date of the test
• Results of the test, indicating the quantitation of pregnancy-associated plasma protein A (PAPP-A)
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 84163, ensure that the test is performed to quantitate pregnancy-associated plasma protein A (PAPP-A). It is important to follow the specific guidelines provided by the payer regarding the use of additional codes for specimen collection. It is also crucial to review any bundling or unbundling rules that may apply to this code.

8. Historical information

CPT 84163 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates to the code since its addition.

9. Examples

1. A pregnant patient undergoes CPT 84163 testing during the first trimester to assess the risk of Down syndrome.
2. A clinician orders CPT 84163 to evaluate a pregnant patient with a history of preeclampsia.
3. A laboratory performs CPT 84163 to quantitate pregnancy-associated plasma protein A (PAPP-A) in a serum sample from a pregnant patient with suspected fetal chromosomal abnormalities.
4. CPT 84163 is used to assess the risk of complications of pregnancy in a pregnant patient with a history of premature delivery.
5. A clinician orders CPT 84163 to evaluate a pregnant patient with a known heart condition and assess the risk of complications during pregnancy.
6. During the first trimester, a pregnant patient undergoes CPT 84163 testing to screen for fetal chromosomal aneuploidies.
7. CPT 84163 is performed on a pregnant patient to assess the risk of miscarriage based on the quantitation of pregnancy-associated plasma protein A (PAPP-A).
8. A clinician orders CPT 84163 to evaluate a pregnant patient with a history of fetal demise in a previous pregnancy.
9. A laboratory performs CPT 84163 to quantitate pregnancy-associated plasma protein A (PAPP-A) in a plasma sample from a pregnant patient with suspected preeclampsia.
10. CPT 84163 is used to assess the risk of complications of pregnancy in a pregnant patient with a history of gestational diabetes.