How To Use CPT Code 95875

CPT 95875 describes the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s). 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 95875?

CPT 95875 can be used to describe the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s). This code is used when a provider performs exercise under an induced ischemic condition to diagnose McArdle disease, a metabolic muscle disease. The test is commonly performed in the forearm, and it involves measuring metabolites like lactic acid, urea, etc., before and after the exercise.

2. Official Description

The official description of CPT code 95875 is: ‘Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s).’ There are no additional notes available for this code.

3. Procedure

1. The provider takes resting baseline samples of blood to measure metabolites like lactic acid, urea, etc.
2. A blood pressure cuff is placed on the patient’s arm and inflated to cause ischemia, restricting blood supply to the area tissues.
3. The patient is instructed to repeat clenching of the fist with full extension of the fingers at about one second cycle time.
4. After one minute of exercise, the provider removes the cuff and takes a series of blood samples at small intervals of a few minutes.
5. The provider analyzes the test results, looking for any significant changes in the levels of metabolites.

4. Qualifying circumstances

CPT 95875 is typically performed to diagnose McArdle disease, a condition characterized by an inability to break down glycogen in the muscles. The test is performed on patients who present symptoms suggestive of McArdle disease, such as muscle pain, cramps, and fatigue during exercise. The provider must use the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) to qualify for reporting this code.

5. When to use CPT code 95875

CPT code 95875 should be used when a provider performs the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) to diagnose McArdle disease or other similar metabolic muscle diseases. It is important to ensure that the test is performed under the specific conditions described in the code description.

6. Documentation requirements

To support a claim for CPT 95875, the provider must document the following information:

• Patient’s symptoms and indications for performing the test
• Baseline measurements of metabolites before the exercise
• Details of the ischemic limb exercise test, including the duration and intensity of exercise
• Serial specimen(s) acquisition for muscle(s) metabolite(s) during and after the exercise
• Analysis of the test results and interpretation
• Signature of the provider performing the test

7. Billing guidelines

When billing for CPT 95875, ensure that the test is performed according to the specific conditions described in the code. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code, unless the hospital provided the technical component. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 95875 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, including code changes in 2002 and 2003, but no updates since then.

9. Examples

1. A provider performs the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) on a patient presenting with muscle pain and fatigue during exercise. The test helps diagnose McArdle disease.
2. A patient with suspected metabolic muscle disease undergoes the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) to measure lactic acid and other metabolites before and after exercise.
3. A provider uses CPT code 95875 to report the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) performed on a patient with symptoms suggestive of a metabolic muscle disorder.
4. The ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) is performed on a patient to assess their muscle metabolism and diagnose any underlying conditions.
5. A provider performs the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) on a patient with suspected McArdle disease to measure the levels of lactic acid and other metabolites during and after exercise.
6. A patient undergoes the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) to evaluate their muscle metabolism and identify any abnormalities.
7. The provider uses CPT code 95875 to report the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) performed on a patient with symptoms suggestive of a metabolic muscle disorder.
8. A patient with suspected McArdle disease undergoes the ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) to assess their muscle metabolism and confirm the diagnosis.