How To Use CPT Code 84165

CPT 84165 describes the process of separating and quantitating components of serum protein through electrophoretic fractionation. 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 84165?

CPT 84165 can be used to describe the laboratory test that separates and quantitates components of serum protein through electrophoretic fractionation. This test helps clinicians diagnose conditions such as cancer, liver or kidney disease, and immune system problems by analyzing the electrophoretic fractionation pattern of serum protein.

2. Official Description

The official description of CPT code 84165 is: ‘Protein; electrophoretic fractionation and quantitation, serum.’

3. Procedure

1. The lab analyst performs the technical steps to separate serum protein into fractions based on shape, size, and electric charge.
2. A serum sample is placed in a gel matrix on a plate or card, and an electric current is applied.
3. The protein components, including albumin, alpha 1 and 2 globulin, beta globulin, and gamma globulin, migrate across the gel at different speeds, creating a specific pattern of component regions.
4. A fluorescent dye is added to reveal the pattern, which the analyst uses to quantitate each fraction.
5. The electrophoretic fractionation pattern helps clinicians identify abnormal proteins or variations in normal protein levels, aiding in the diagnosis of various conditions.

4. Qualifying circumstances

CPT 84165 is performed when a clinician suspects conditions such as cancer, rheumatoid arthritis, liver disease, and inflammatory problems. The test helps identify abnormal proteins or variations in normal protein levels that may indicate these conditions. It is important to note that CPT 84165 specifically applies to serum protein electrophoresis and should not be confused with similar tests for other fluids.

5. When to use CPT code 84165

CPT code 84165 should be used when a clinician orders serum protein electrophoresis to assess the presence of abnormal proteins or variations in normal protein levels. It is appropriate to bill this code when the test is performed on serum samples and not on other fluids.

6. Documentation requirements

To support a claim for CPT 84165, the documentation should include:

• Reason for ordering the test, including suspected conditions
• Details of the electrophoretic fractionation procedure performed
• Results of the test, including any abnormal protein patterns or variations in normal protein levels
• Signature of the lab analyst who performed the test

7. Billing guidelines

When billing for CPT 84165, ensure that the test is performed on serum samples and not on other fluids. It is important to use the appropriate code for collecting the specimen, such as CPT code 36415 for venous blood collection. Additionally, consider payer policies regarding separate reimbursement for specimen collection.

8. Historical information

CPT 84165 has undergone historical changes. It was initially added to the Current Procedural Terminology system on January 1, 1990, with subsequent code changes on January 1, 2004, and January 1, 2005.

9. Examples

1. A clinician orders CPT 84165 to assess the electrophoretic fractionation pattern of serum protein in a patient suspected of having multiple myeloma.
2. During a routine check-up, a clinician orders CPT 84165 to evaluate the serum protein electrophoresis of a patient with suspected liver disease.
3. A patient with symptoms of rheumatoid arthritis undergoes CPT 84165 to analyze the electrophoretic fractionation pattern of serum protein.
4. A clinician orders CPT 84165 to assess the serum protein electrophoresis of a patient with suspected immune system problems.
5. As part of a comprehensive diagnostic workup, a clinician orders CPT 84165 to evaluate the electrophoretic fractionation pattern of serum protein in a patient with unexplained weight loss.
6. Provide four more original examples of cases where CPT 84165 should be billed. Do not include ‘CPT 84165’ or ‘CPT code 84165’ in the text of an example.