CPT® Code 78270 | Case2Code

Official Description

Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor

Common Language Description

The Vitamin B-12 absorption study, identified by CPT® Code 78270, is a laboratory test designed to assess the body's ability to absorb Vitamin B-12, also known as cobalamin. This vitamin plays a crucial role in several vital physiological processes, including the production of red blood cells (RBCs), the replication of DNA and RNA for cellular development, and the proper functioning of the nervous system. The test is particularly significant in the evaluation of patients suspected of having pernicious anemia, a condition characterized by the inability to absorb Vitamin B-12 due to a lack of intrinsic factor, a protein necessary for absorption. The procedure involves administering an oral dose of Vitamin B-12 that is labeled with a radioactive isotope, such as Cobalt 57 or Cobalt 58, to track its absorption. Following the oral administration, a 24-hour urine collection is initiated to measure the amount of labeled Vitamin B-12 excreted, which indicates how much has been absorbed by the gastrointestinal tract. This test is part of a series of assessments, including Stage II and dual isotope tests, which further evaluate absorption issues and help differentiate between various underlying conditions affecting Vitamin B-12 absorption.

1. Indications

The Vitamin B-12 absorption study (CPT® Code 78270) is indicated for the following conditions:

Pernicious Anemia - A condition where the body cannot absorb Vitamin B-12 due to a deficiency of intrinsic factor.
Vitamin B-12 Deficiency - To evaluate the cause of low levels of Vitamin B-12 in the body.
Malabsorption Syndromes - To assess the gastrointestinal tract's ability to absorb nutrients effectively.

2. Procedure

The procedure for the Vitamin B-12 absorption study involves several key steps to accurately measure the absorption of Vitamin B-12:

Step 1: Administration of Oral Vitamin B-12 - The patient is given an oral dose of Vitamin B-12 that is labeled with an isotope tracer, such as Cobalt 57 or Cobalt 58. This tracer allows for the tracking of the Vitamin B-12 as it passes through the gastrointestinal system.
Step 2: Initiation of Urine Collection - A 24-hour urine collection is started immediately after the oral administration of the labeled Vitamin B-12. This collection is crucial for measuring the amount of Vitamin B-12 that is absorbed and subsequently excreted by the body.
Step 3: Intramuscular Injection of Vitamin B-12 - One to two hours after the oral dose, the patient receives an intramuscular injection of Vitamin B-12. This injection serves to saturate the binding sites for Vitamin B-12 in the body, ensuring that any absorption measured is due to the oral dose and not influenced by the body's stores.
Step 4: Laboratory Analysis - At the conclusion of the 24-hour urine collection, the urine sample is sent to the laboratory for analysis. The laboratory tests the sample to determine the percentage of the labeled Vitamin B-12 that has been excreted, which indicates the amount absorbed by the gastrointestinal tract.

3. Post-Procedure

After the completion of the Vitamin B-12 absorption study, the patient may resume normal activities. The results of the test will be interpreted by the physician, who will provide a written report detailing the findings. This report is essential for determining the underlying cause of any Vitamin B-12 absorption issues and guiding further diagnostic or therapeutic interventions as necessary. It is important for the healthcare provider to discuss the results with the patient and consider any additional testing or treatment options based on the findings.

Short Descr	VIT B-12 ABSORPTION EXAM
Medium Descr	VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR
Long Descr	Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1E - Standard imaging - nuclear medicine
MUE	Not applicable/unspecified.
CCS Clinical Classification	209 - Radioisotope scan and function studies