CPT® Code 78271

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1. Indications

The CPT® Code 78271 is indicated for use in the evaluation of patients suspected of having Vitamin B-12 absorption issues, particularly in the context of pernicious anemia. The following conditions may warrant the performance of this test:

• Pernicious Anemia - A condition where the body cannot absorb Vitamin B-12 due to a lack of intrinsic factor.
• Vitamin B-12 Deficiency - Symptoms may include fatigue, weakness, and neurological issues, prompting the need for assessment of absorption capabilities.
• Malabsorption Syndromes - Conditions that affect the gastrointestinal tract's ability to absorb nutrients, including Vitamin B-12.

2. Procedure

The procedure for the Stage II Schilling test, represented by CPT® Code 78271, involves several critical steps to accurately assess Vitamin B-12 absorption:

• Step 1: Administration of 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 58. This tracer allows for the measurement of the Vitamin B-12 that is absorbed by the body.
• Step 2: Administration of Intrinsic Factor - Along with the isotope-labeled Vitamin B-12, the patient is also administered an oral dose of intrinsic factor. This step is crucial as it helps to determine if the absorption issue is due to a lack of intrinsic factor, which is characteristic of pernicious anemia.
• Step 3: Urine Collection - A 24-hour urine collection is initiated to capture all urine produced during this period. This collection is essential for measuring the amount of labeled Vitamin B-12 that is excreted, which reflects the amount absorbed by the gastrointestinal tract.
• Step 4: Intramuscular Injection of Vitamin B-12 - One to two hours after the oral administration of the labeled Vitamin B-12, the patient receives an intramuscular injection of Vitamin B-12. This injection saturates the B-12 binding sites in the body, ensuring that any absorption measured is due to the oral dose given.
• Step 5: 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 excreted labeled Vitamin B-12, which indicates the amount absorbed by the gastrointestinal tract.

3. Post-Procedure

After the completion of the Stage II Schilling test, 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 will indicate whether the absorption of Vitamin B-12 is normal or if there are abnormalities that suggest conditions such as pernicious anemia or other malabsorption issues. Follow-up care may be necessary based on the results, and further testing or treatment may be recommended to address any identified deficiencies or underlying conditions.