CPT® Code 85421

Official Description

Fibrinolytic factors and inhibitors; plasminogen, antigenic assay

Common Language Description

The CPT® Code 85421 refers to a laboratory test specifically designed to measure the levels of plasminogen antigen in the blood. Plasminogen is a protein produced by the liver that circulates in an inactive form until it binds to a clot or cell surface, where it is then activated to plasmin. This activation process is facilitated by various factors, including tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), kallikrein, and factor XII (Hageman). The measurement of plasminogen antigen is crucial for evaluating patients who may have inherited genetic deficiencies related to plasminogen, such as hypoplasminogenemia (Type I deficiency) or dysplasminogenemia (Type 2 deficiency). Type I deficiency is characterized by a systemic disorder that impairs extracellular fibrinolysis, leading to the formation of fibrin-rich pseudomembranous lesions, particularly noticeable in the conjunctiva, known as ligneous conjunctiva. In this type, there is a parallel decrease in both immunoreaction and functional activity, but it does not increase the risk of thrombophilia. Conversely, Type 2 deficiency presents with normal or slightly decreased levels of circulating plasminogen, yet the functional activity is significantly reduced. The test is performed by obtaining a blood sample through a separately reportable venipuncture, and the analysis is conducted using enzyme-linked immunosorbent assay (ELISA) on serum, plasma, or cultured cells.

1. Indications

The fibrinolytic factors and inhibitors test, coded as CPT® 85421, is indicated for the evaluation of specific inherited genetic deficiency disorders related to plasminogen. The following conditions warrant the performance of this test:

Hypoplasminogenemia (Type I deficiency) - This condition is characterized by a systemic disorder that leads to impaired extracellular fibrinolysis, resulting in the formation of fibrin-rich pseudomembranous lesions during wound healing, particularly affecting the conjunctiva.
Dysplasminogenemia (Type 2 deficiency) - In this disorder, there is a normal or slightly decreased level of circulating plasminogen, but the functional activity of plasminogen is markedly diminished, which can impact the fibrinolytic process.

2. Procedure

The procedure for conducting the plasminogen antigenic assay involves several key steps, which are outlined as follows:

Step 1: Sample Collection - A blood sample is obtained from the patient through a venipuncture. This step is crucial as it provides the necessary specimen for testing plasminogen levels. The venipuncture must be performed in a sterile manner to avoid contamination and ensure accurate results.
Step 2: Sample Preparation - Once the blood sample is collected, it is processed to separate the serum or plasma. This may involve centrifugation to ensure that the cellular components are removed, leaving only the liquid portion of the blood for analysis.
Step 3: Testing Methodology - The prepared serum or plasma is then subjected to an enzyme-linked immunosorbent assay (ELISA). This testing method is designed to quantify the levels of plasminogen antigen present in the sample, providing critical information regarding the patient's plasminogen status.

3. Post-Procedure

After the completion of the plasminogen antigenic assay, the laboratory will analyze the results and report the findings. It is essential for healthcare providers to interpret these results in the context of the patient's clinical presentation and history. Depending on the outcomes, further diagnostic testing or clinical evaluations may be warranted to confirm any suspected deficiencies or to guide treatment options. Patients may be advised on any necessary follow-up appointments or additional tests based on the results of this assay.

Short Descr	FIBRINOLYTIC PLASMINOGEN
Medium Descr	FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY
Long Descr	Fibrinolytic factors and inhibitors; plasminogen, 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	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.