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The CPT® Code 85380 refers to the testing of fibrin degradation products, specifically the D-dimer, using an ultrasensitive method. This test is crucial in the evaluation of venous thromboembolism, which includes conditions such as deep vein thrombosis and pulmonary embolism. The D-dimer test serves as a valuable diagnostic tool, particularly in ruling out the presence of a thrombus, which is a blood clot that can obstruct blood flow. 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 level of these degradation products, which may suggest the presence of a thrombus. Additionally, D-dimer testing is utilized to assess hypercoagulability, a condition that increases the risk of blood clots, and to aid in the diagnosis of disseminated intravascular coagulation (DIC). This condition is characterized by the widespread activation of the clotting process in the blood vessels, leading to the formation of small blood clots throughout the body. The D-dimer test can also be instrumental in monitoring the effectiveness of treatment for DIC. It is important to note that there are different methodologies for D-dimer testing. The CPT® Code 85379 is used for quantitative testing, which provides a specific level of fibrin degradation products in the specimen. In contrast, CPT® Codes 85378 and 85380 are designated for qualitative and semiquantitative testing, respectively. Code 85380 specifically refers to ultrasensitive testing, which is designed to deliver rapid and highly accurate results due to its enhanced sensitivity compared to standard testing methods.
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The D-dimer test, represented by CPT® Code 85380, is indicated for several clinical scenarios, particularly in the evaluation of thromboembolic conditions. The following are the primary indications for performing this test:
The procedure for conducting the D-dimer test under CPT® Code 85380 involves several key steps, which are outlined below:
After the D-dimer test is completed, the patient may be advised to await the results, which are typically available within a short timeframe due to the rapid nature of the ultrasensitive testing method. Depending on the results, further diagnostic imaging or clinical evaluation may be necessary to confirm or rule out the presence of thromboembolic conditions. It is essential for healthcare providers to communicate the results to the patient and discuss any subsequent steps or treatments that may be required based on the findings of the D-dimer test.
| Short Descr | FIBRIN DEGRADJ D-DIMER | Medium Descr | FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE | Long Descr | Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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