How To Use CPT Code 84206

CPT 84206 describes the measurement of proinsulin levels in a patient’s specimen, typically plasma. 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 84206?

CPT 84206 can be used to measure the levels of proinsulin in a patient’s specimen, usually plasma. This code is used when a lab analyst performs a test to evaluate the proinsulin levels using methods such as immunoassay and chemiluminescence.

2. Official Description

The official description of CPT code 84206 is: ‘Measurement of proinsulin in a patient specimen such as plasma.’

3. Procedure

1. The lab analyst collects a patient specimen, typically plasma, for testing.
2. The lab analyst performs a test using methods such as immunoassay and chemiluminescence to measure the levels of proinsulin in the specimen.
3. The lab analyst visualizes and measures the antibody proinsulin complex to determine the proinsulin levels.

4. Qualifying circumstances

CPT 84206 is used when clinicians order the test to help diagnose or evaluate the risk for conditions such as insulinoma or proprotein convertase 1 3 deficiency (PC1 3 deficiency). Insulinoma is a tumor of the pancreas beta cells that produce insulin, while PC1 3 deficiency is a genetic disorder associated with elevated proinsulin levels and other hormonal abnormalities.

5. When to use CPT code 84206

CPT code 84206 should be used when a lab analyst performs a test to measure the levels of proinsulin in a patient’s specimen, such as plasma. It is appropriate to bill this code when the test is ordered to diagnose or evaluate the risk for conditions related to proinsulin levels.

6. Documentation requirements

To support a claim for CPT 84206, the documentation should include:

• Indication for the test, such as the suspected condition or risk evaluation
• Details of the specimen collected, including the type (plasma) and collection method
• Description of the test performed, including the methods used (immunoassay, chemiluminescence)
• Results of the test, specifically the measured proinsulin levels
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 84206, ensure that the test is performed by a lab analyst and that the documentation supports the medical necessity of the test. It is important to follow any specific guidelines provided by the payer regarding specimen collection and billing codes for related services. Report CPT 84206 separately and do not report it if other specific codes, such as 82480 for pseudocholinesterase, are already performed in the previous seven days.

8. Historical information

CPT 84206 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 lab analyst measures the proinsulin levels in a patient’s plasma specimen to evaluate the risk of insulinoma.
2. A clinician orders a proinsulin test to diagnose PC1 3 deficiency in a patient with hormonal abnormalities and elevated proinsulin levels.
3. A lab analyst performs a proinsulin test on a plasma specimen to assess the risk of morbid obesity in a patient with infertility.
4. A clinician orders a proinsulin test to evaluate the risk of insulin resistance in a patient with metabolic syndrome.
5. A lab analyst measures the proinsulin levels in a patient’s plasma specimen to monitor the effectiveness of a treatment for insulin-related disorders.
6. A clinician orders a proinsulin test to assess the risk of gestational diabetes in a pregnant patient.
7. A lab analyst performs a proinsulin test on a plasma specimen to evaluate the risk of hypoglycemia in a patient with recurrent episodes.
8. A clinician orders a proinsulin test to diagnose a patient with suspected insulin autoimmune syndrome.
9. A lab analyst measures the proinsulin levels in a patient’s plasma specimen to evaluate the risk of developing type 2 diabetes.
10. A clinician orders a proinsulin test to assess the risk of hyperinsulinemic hypoglycemia in a patient with recurrent low blood sugar episodes.