How To Use CPT Code 95857

CPT 95857 describes the cholinesterase inhibitor challenge test for myasthenia gravis. 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 95857?

CPT 95857 can be used to describe the cholinesterase inhibitor challenge test for myasthenia gravis. This test involves the injection of a cholinesterase inhibitor, such as edrophonium, into the vein of a patient suspected of having myasthenia gravis. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness and fatigue. The goal of this test is to administer a drug that blocks the enzymatic effect of the acetylcholinesterase enzyme, thereby prolonging the presence of acetylcholine at the neuromuscular junction. This allows acetylcholine to stimulate muscle contraction for a longer time, reducing muscle fatigue or weakness.

2. Official Description

The official description of CPT code 95857 is: ‘Cholinesterase inhibitor challenge test for myasthenia gravis.’

3. Procedure

  1. The provider injects a cholinesterase inhibitor, such as edrophonium, into the vein of the patient suspected of having myasthenia gravis.
  2. The presence of the cholinesterase inhibitor prolongs the effect of acetylcholine at the neuromuscular junction, allowing for prolonged muscle contraction.
  3. The provider observes the patient for any improvement in muscle strength or reduction in symptoms.
  4. If there is a significant improvement in muscle strength or reduction in symptoms, it may indicate a diagnosis of myasthenia gravis.
  5. If there is no improvement, further testing may be necessary to determine the cause of the patient’s symptoms.

4. Qualifying circumstances

CPT 95857 is used for patients suspected of having myasthenia gravis, a neuromuscular disease characterized by muscle weakness and fatigue. The test is performed to diagnose myasthenia gravis and differentiate it from other diseases. It is important to note that this test is also known as a Tensilon test.

5. When to use CPT code 95857

CPT code 95857 should be used when performing a cholinesterase inhibitor challenge test for myasthenia gravis. It is appropriate to use this code when the provider injects a cholinesterase inhibitor into the vein of a patient suspected of having myasthenia gravis and observes for any improvement in muscle strength or reduction in symptoms.

6. Documentation requirements

To support a claim for CPT 95857, the provider must document the following information:

  • Patient’s suspected diagnosis of myasthenia gravis
  • Details of the cholinesterase inhibitor used, such as edrophonium
  • Date and time of the test
  • Observations of the patient’s muscle strength and symptoms before and after the test
  • Any additional testing or follow-up required
  • Provider’s signature

7. Billing guidelines

When billing for CPT 95857, ensure that the test is performed for the purpose of diagnosing myasthenia gravis. It is important to note that the entity bearing the cost of the injected drug may report it separately. Consider the location of the testing, as pulmonary function tests have both a professional and technical component. Modifier 26 should be used when reporting 95857 with modifier 26, and the facility should report 95857 with modifier TC.

8. Historical information

CPT 95857, previously known as the Tensilon test for myasthenia gravis, was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2011.

9. Examples

  1. A patient suspected of having myasthenia gravis undergoes a cholinesterase inhibitor challenge test. The provider injects edrophonium into the patient’s vein and observes for any improvement in muscle strength or reduction in symptoms.
  2. Another patient with symptoms suggestive of myasthenia gravis undergoes a Tensilon test. The provider administers a cholinesterase inhibitor and monitors the patient for any changes in muscle strength or symptoms.
  3. A third patient presents with muscle weakness and fatigue, and the provider suspects myasthenia gravis. The provider performs a cholinesterase inhibitor challenge test by injecting edrophonium and assessing the patient’s response.
  4. A provider evaluates a patient with suspected myasthenia gravis and decides to perform a Tensilon test. The patient receives an injection of a cholinesterase inhibitor, and the provider observes for any improvement in muscle strength or reduction in symptoms.
  5. In another case, a patient presents with symptoms consistent with myasthenia gravis, and the provider decides to perform a cholinesterase inhibitor challenge test. The patient receives an injection of edrophonium, and the provider monitors for any changes in muscle strength or symptoms.
  6. A provider suspects myasthenia gravis in a patient and performs a Tensilon test. The patient receives an injection of a cholinesterase inhibitor, and the provider assesses for any improvement in muscle strength or reduction in symptoms.
  7. Another patient undergoes a cholinesterase inhibitor challenge test for suspected myasthenia gravis. The provider administers edrophonium and observes for any changes in muscle strength or symptoms.
  8. A provider performs a Tensilon test on a patient with symptoms suggestive of myasthenia gravis. The patient receives an injection of a cholinesterase inhibitor, and the provider monitors for any improvement in muscle strength or reduction in symptoms.

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