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The CPT® Code 85378 refers to the qualitative or semiquantitative testing of fibrin degradation products, specifically focusing on D-dimer. D-dimer testing is a crucial laboratory procedure utilized primarily to assist in ruling out the presence of a thrombus, which is a blood clot that can obstruct blood flow. The significance of D-dimer lies in its negative predictive value; a negative result from this test indicates that there are no elevated levels of fibrin degradation products in the specimen, suggesting that a thrombus is unlikely. Conversely, a positive result signifies an abnormally high concentration of fibrin degradation products, which may suggest the presence of a thrombus. This test is particularly valuable in diagnosing conditions such as deep vein thrombophlebitis, pulmonary embolism, and stroke. Additionally, D-dimer testing is employed to evaluate hypercoagulability, a condition that increases the risk of blood clots, and to assist in diagnosing disseminated intravascular coagulation (DIC). Furthermore, it can be used to monitor the effectiveness of treatment for DIC. It is important to note that while CPT® Code 85378 encompasses qualitative and semiquantitative testing methodologies, it is distinct from CPT® Code 85379, which involves a quantitative assessment providing specific levels of fibrin degradation products. The testing methodology associated with CPT® Code 85378 is less sensitive compared to that of CPT® Code 85380, which is designed for ultrasensitive testing, yielding rapid and highly accurate results due to its enhanced sensitivity.
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The D-dimer test, represented by CPT® Code 85378, is indicated for several clinical scenarios where the presence of thrombus or hypercoagulability is suspected. The following conditions warrant the use of this test:
The procedure for conducting the D-dimer test under CPT® Code 85378 involves several key steps that ensure accurate results. The following outlines the procedural steps:
Post-procedure care for patients undergoing D-dimer testing is generally minimal, as the test is non-invasive and involves only a blood draw. Patients may be advised to maintain hydration and can typically resume normal activities immediately following the procedure. It is important for healthcare providers to communicate the significance of the test results to the patient, including any necessary follow-up actions based on the outcomes. If the D-dimer test results are positive, further diagnostic imaging or clinical evaluation may be warranted to confirm the presence of a thrombus or to investigate other underlying conditions. In cases where the test is negative, it may provide reassurance regarding the absence of significant thrombotic events.
| Short Descr | FIBRIN DEGRADE SEMIQUANT | Medium Descr | FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN | Long Descr | Fibrin degradation products, D-dimer; qualitative or semiquantitative | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 233 - Laboratory - Chemistry and Hematology |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care |
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| 2011-01-01 | Changed | Short description changed. |
| 2003-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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