How To Use CPT Code 85378

CPT 85378 describes the qualitative or semiquantitative testing of fibrin degradation products, specifically D-dimer, in patient blood or 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 85378?

CPT 85378 can be used to describe the testing of D-dimer levels in patient blood or plasma. This code is used when a lab analyst performs a qualitative or semiquantitative test to determine the presence of D-dimer at clinically significant levels. The test may involve steps such as mixing patient blood with a D-dimer specific antibody, resulting in a colorimetric reaction at specific concentrations.

2. Official Description

The official description of CPT code 85378 is: ‘Fibrin degradation products, D-dimer; qualitative or semiquantitative.’

3. Procedure

1. The lab analyst performs a test using patient blood or plasma to determine the presence of D-dimer at clinically significant levels.
2. The test may involve steps such as mixing patient blood with a D-dimer specific antibody, resulting in a colorimetric reaction at specific concentrations.
3. Other test methods may be used, such as a risk score, to provide a semiquantitative result.
4. The test is performed to detect D-dimer levels in patient blood that can indicate or exclude specific clinical conditions.

4. Qualifying circumstances

CPT 85378 is used when clinicians order the test to rule out conditions such as pulmonary embolism or deep vein thrombosis, or to aid in the diagnosis of disseminated intravascular coagulation (DIC). The test is not limited to testing for a specific condition.

5. When to use CPT code 85378

CPT code 85378 should be used when a qualitative or semiquantitative D-dimer test is performed to detect the presence or measure the quantity of D-dimer in patient blood or plasma. It is important to distinguish this code from quantitative D-dimer tests (CPT 85379) or ultrasensitive D-dimer tests (CPT 85380).

6. Documentation requirements

To support a claim for CPT 85378, the documentation should include:

• Indication for the test and its clinical relevance
• Details of the test method used, such as qualitative immunochromatographic assay or other immunoassay
• Results of the test, indicating the presence or absence of D-dimer at clinically significant levels
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 85378, it is important to ensure that the test is performed by a lab analyst using a qualitative or semiquantitative method. This code should not be reported with other codes for specimen collection, such as venipuncture (CPT 36415). It is also crucial to distinguish between qualitative or semiquantitative D-dimer tests (CPT 85378) and quantitative D-dimer tests (CPT 85379) or ultrasensitive D-dimer tests (CPT 85380).

8. Historical information

CPT 85378 was added to the Current Procedural Terminology system on January 1, 1993. There have been historical changes to the code, including a code change on January 1, 2003, which specified that the code represents semiquantitative testing.

9. Examples

1. A lab analyst performs a qualitative D-dimer test on patient blood to rule out pulmonary embolism.
2. A lab analyst uses a semiquantitative D-dimer test to aid in the diagnosis of disseminated intravascular coagulation (DIC) in a patient.
3. A qualitative D-dimer test is performed on patient plasma to exclude deep vein thrombosis.
4. A lab analyst performs a semiquantitative D-dimer test as part of a risk score assessment for a patient with suspected thrombotic disorder.
5. A qualitative D-dimer test is performed on patient blood to evaluate the effectiveness of anticoagulant therapy.
6. A lab analyst uses a semiquantitative D-dimer test to monitor the progression of a patient’s coagulation disorder.
7. A qualitative D-dimer test is performed on patient plasma to assess the risk of thrombosis in a high-risk individual.
8. A lab analyst performs a semiquantitative D-dimer test to aid in the diagnosis of a clotting disorder in a pediatric patient.
9. A qualitative D-dimer test is performed on patient blood to rule out thromboembolic events after surgery.
10. A lab analyst uses a semiquantitative D-dimer test to assess the risk of venous thromboembolism in a pregnant patient.