CPT® Code 85420

Official Description

Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay

Common Language Description

The CPT® Code 85420 refers to a laboratory test that assesses fibrinolytic factors and inhibitors, specifically measuring plasminogen activity, excluding antigenic assays. Plasminogen is a crucial protein produced by the liver, existing in an inactive form within the bloodstream until it binds to a clot or cell surface. Upon activation, plasminogen converts to plasmin through the action of various activators, including tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), kallikrein, and factor XII (Hageman). This test is significant as it helps in identifying abnormalities in plasminogen levels, which can be indicative of various medical conditions. Decreased plasminogen levels may arise from inherited genetic disorders or can be acquired due to conditions such as disseminated intravascular coagulation (DIC), liver disease, thrombolytic therapy, or the use of L-asparaginase. Conversely, elevated plasminogen levels have been associated with factors such as anabolic steroid use, hypothyroidism, hormonal contraceptives, infections, inflammation, trauma, and pregnancy. The measurement of plasminogen activity is particularly useful in evaluating patients who experience incidental or recurrent thromboembolic events, have a family history of arterial or venous thrombophilia, or present with ligneous conjunctiva. In cases where plasminogen activity is found to be abnormal, further testing for plasminogen antigen (CPT® Code 85421) may be warranted to investigate potential genetic disorders. The test is performed on a blood sample, which is obtained through a separately reportable venipuncture, and the analysis is conducted on platelet-poor plasma using a chromogenic assay.

1. Indications

The CPT® Code 85420 is indicated for use in various clinical scenarios where the evaluation of plasminogen activity is necessary. The following conditions and situations warrant this laboratory test:

Incidental or Recurrent Thromboembolic Events - Patients who have experienced unexpected or repeated occurrences of blood clots may require this test to assess their plasminogen levels.
Family History of Arterial or Venous Thrombophilia - Individuals with a familial predisposition to clotting disorders may be tested to determine if plasminogen activity is contributing to their risk.
Ligneous Conjunctiva - This rare condition, characterized by the presence of a gelatinous membrane in the conjunctiva, may necessitate plasminogen testing to evaluate underlying fibrinolytic issues.

2. Procedure

The procedure for conducting the test associated with CPT® Code 85420 involves several key steps to ensure accurate measurement of plasminogen activity. The following outlines the procedural steps:

Step 1: Patient Preparation - Prior to the test, the patient may need to be informed about any necessary preparations, such as fasting or avoiding certain medications that could affect the results.
Step 2: Venipuncture - A qualified healthcare professional performs a venipuncture to obtain a blood sample from the patient. This step is crucial as the sample must be collected in a manner that minimizes contamination and ensures the integrity of the plasma for testing.
Step 3: Plasma Preparation - After collection, the blood sample is processed to separate the platelet-poor plasma. This is typically done through centrifugation, which helps to remove cellular components and obtain a clear plasma sample for analysis.
Step 4: Chromogenic Assay - The prepared platelet-poor plasma is then subjected to a chromogenic assay, a specific laboratory technique used to measure the functional activity of plasminogen. This assay provides quantitative results that reflect the plasminogen levels in the sample.

3. Post-Procedure

After the completion of the plasminogen activity test, the patient may be monitored briefly to ensure there are no immediate complications from the venipuncture. The results of the test will typically be analyzed and reported back to the healthcare provider, who will interpret the findings in the context of the patient's clinical history and symptoms. If the plasminogen activity is found to be abnormal, further testing, such as the plasminogen antigen test (CPT® Code 85421), may be recommended to explore potential genetic disorders or other underlying conditions. Patients should be informed about the timeline for receiving results and any follow-up actions that may be necessary based on the outcomes of the test.

Short Descr	FIBRINOLYTIC PLASMINOGEN
Medium Descr	FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS
Long Descr	Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay
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

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.

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.