How To Use CPT Code 84681

CPT 84681 describes the measurement of C-peptide, a byproduct of insulin produced by the pancreas. 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 84681?

CPT 84681 is used to measure C-peptide, which is a byproduct of insulin produced by the pancreas. This test helps distinguish between Type 1 and Type 2 diabetes, evaluate tumors of the pancreas, find the cause of low blood sugar, and determine if a patient needs insulin injections.

2. Official Description

The official description of CPT code 84681 is: ‘Measurement of C-peptide.’

3. Procedure

1. A lab analyst performs the technical steps to measure C-peptide on a blood specimen from a fasting patient.
2. The test may involve a 24-hour urine specimen if ordered by the clinician.
3. The lab analyst measures C-peptide using various methods, such as immunoassay, which utilizes an antigen-antibody response to measure the analyte.
4. The result of the C-peptide measurement corresponds to the amount of insulin being produced by the pancreas.
5. This test helps in distinguishing between Type 1 and Type 2 diabetes, evaluating tumors of the pancreas, finding the cause of low blood sugar, and determining if the patient needs insulin injections.

4. Qualifying circumstances

CPT 84681 is performed on patients who require measurement of C-peptide to aid in the diagnosis and management of their condition. It is commonly used to distinguish between Type 1 and Type 2 diabetes, evaluate pancreatic tumors, and assess insulin production. The test is typically ordered by a clinician based on the patient’s symptoms and medical history.

5. When to use CPT code 84681

CPT code 84681 should be used when a clinician orders the measurement of C-peptide to aid in the diagnosis and management of a patient’s condition. It is appropriate to bill this code when performing the test on a fasting patient using a blood specimen. If the clinician orders a 24-hour urine specimen for C-peptide measurement, a different code may be used.

6. Documentation requirements

To support a claim for CPT 84681, the following documentation is required:

• Reason for ordering the C-peptide measurement
• Type of specimen used (blood or urine)
• Method used to measure C-peptide (e.g., immunoassay)
• Date and time of the test
• Results of the C-peptide measurement
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 84681, ensure that the test is performed on a fasting patient using a blood specimen. If a 24-hour urine specimen is used, a different code may be appropriate. It is important to follow the specific guidelines provided by the payer and accurately document the necessary information to support the claim.

8. Historical information

CPT 84681 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 clinician orders the measurement of C-peptide to distinguish between Type 1 and Type 2 diabetes in a patient with uncontrolled blood sugar levels.
2. A patient with suspected pancreatic tumor undergoes C-peptide measurement to aid in the evaluation and diagnosis of the condition.
3. A clinician orders the test to determine the cause of recurrent episodes of low blood sugar in a patient without a history of diabetes.
4. A patient with newly diagnosed diabetes undergoes C-peptide measurement to assess their insulin production and determine the appropriate treatment plan.
5. A clinician orders the test to monitor the effectiveness of insulin therapy in a patient with Type 1 diabetes.
6. A patient with symptoms of insulin resistance undergoes C-peptide measurement to aid in the diagnosis of Type 2 diabetes.
7. A clinician orders the test to evaluate the need for insulin injections in a patient with gestational diabetes.
8. A patient with suspected insulinoma undergoes C-peptide measurement to assess the presence of a pancreatic tumor.
9. A clinician orders the test to evaluate the cause of hypoglycemia in a patient with a history of gastric bypass surgery.
10. A patient with unexplained weight loss and fatigue undergoes C-peptide measurement to aid in the diagnosis of diabetes.