CPT® Code 85415

Official Description

Fibrinolytic factors and inhibitors; plasminogen activator

Common Language Description

The CPT® Code 85415 refers to a laboratory test that measures fibrinolytic factors and inhibitors, specifically focusing on plasminogen activator. This test evaluates the activity of plasminogen activator inhibitor type I (PAI-I), which is a serine protease inhibitor produced primarily by endothelial cells and adipose tissue, as well as by the placenta (referred to as PAI-2). The role of plasminogen activator is crucial in the regulation of fibrinolysis, a process that prevents blood clots from growing and becoming problematic. It specifically targets tissue plasminogen activator (tPA) and urokinase plasminogen activator (uPA) to modulate this process. A deficiency in PAI-I, which can be inherited, may lead to delayed mild to moderate bleeding, particularly after trauma or surgical procedures. Conversely, elevated levels of PAI-I can be indicative of various health conditions, including certain types of cancers such as breast, gastric, lung, and cervical cancers, as well as obesity, metabolic syndrome, and inflammatory disorders. The test is performed on a blood sample that is obtained through a separately reportable venipuncture. The analysis involves testing platelet-poor plasma for PAI-I activity using a bioimmunoassay and measuring tissue plasminogen activator antigen through an enzyme-linked immunosorbent assay (ELISA).

1. Indications

The laboratory test associated with CPT® Code 85415 is indicated for the evaluation of conditions related to fibrinolytic activity and the regulation of blood clotting. The following are specific indications for performing this test:

Inherited Genetic Disorders A deficiency of plasminogen activator inhibitor type I (PAI-I) can lead to delayed mild to moderate bleeding, particularly following trauma or surgical interventions.
Certain Cancers Elevated levels of PAI-I may be associated with various malignancies, including breast, gastric, lung, and cervical cancers.
Obesity Increased PAI-I levels can be observed in individuals with obesity, which may contribute to altered fibrinolytic activity.
Metabolic Syndrome This condition, characterized by a cluster of metabolic risk factors, may also lead to elevated PAI-I levels.
Inflammatory Disorders Conditions that provoke inflammation can result in increased levels of PAI-I, impacting the fibrinolytic system.

2. Procedure

The procedure for testing plasminogen activator inhibitor I activity involves several key steps, which are outlined below:

Step 1: Blood Sample Collection A blood sample is obtained from the patient through a venipuncture, which is a procedure where a needle is inserted into a vein to collect blood. This step is crucial as it provides the necessary specimen for subsequent testing.
Step 2: Preparation of Platelet-Poor Plasma After the blood sample is collected, it is processed to obtain platelet-poor plasma. This is achieved by centrifuging the blood sample, which separates the plasma from the cellular components, ensuring that the plasma is free from platelets that could interfere with the test results.
Step 3: Testing for PAI-I Activity The platelet-poor plasma is then subjected to a bioimmunoassay to measure the activity of plasminogen activator inhibitor type I (PAI-I). This assay quantifies the inhibitor's ability to regulate fibrinolysis.
Step 4: Testing for tPA Antigen In addition to measuring PAI-I activity, the same plasma sample is tested for tissue plasminogen activator (tPA) antigen using an enzyme-linked immunosorbent assay (ELISA). This step provides further insight into the fibrinolytic system's status.

3. Post-Procedure

After the completion of the laboratory tests, there are no specific post-procedure care requirements for the patient, as the venipuncture site may be bandaged to prevent bleeding. Patients are typically advised to maintain normal activities unless otherwise directed by their healthcare provider. The results of the tests will be analyzed and interpreted by a qualified healthcare professional, who will discuss the findings with the patient and determine any necessary follow-up actions based on the results.

Short Descr	FIBRINOLYTIC PLASMINOGEN
Medium Descr	FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR
Long Descr	Fibrinolytic factors and inhibitors; plasminogen activator
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	2
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.
91	Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit