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Itraconazole is classified as a triazole antifungal medication, primarily utilized in adults for the treatment of various fungal infections. These infections may affect the lungs, where they can potentially spread, as well as cause yeast infections in the mouth, throat, or esophagus. Additionally, itraconazole is effective against fungal infections of the toenails and fingernails. The therapeutic levels of itraconazole are crucial for assessing the systemic absorption of the medication when taken orally, as well as for monitoring potential toxicity. Toxicity from itraconazole can lead to severe complications, including seizures, respiratory difficulties, and heart attacks. Symptoms indicative of toxicity may include blurred or double vision, tinnitus (ringing in the ears), and urinary incontinence. Therapeutic serum levels are typically measured to ensure efficacy and safety, with ranges from above 0.5 mcg/mL for localized infections to 1.0 mcg/mL for systemic infections. These levels are determined using advanced laboratory techniques such as high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection, liquid chromatography-mass spectrometry (LC-MS), or tandem mass spectrometry (LC/MS-MS). In cases where the active metabolite, hydroxyitraconazole, is also assessed, target values for both itraconazole and its metabolite are considered to be around 1.5 mcg/mL combined. The analytical process involves preparing a serum sample mixture or analyte in a solvent, which is then pumped through a chromatographic column under high pressure, propelled by a stream of helium or nitrogen gas. The liquid is nebulized into a fine spray, ionized, and subsequently transferred to the mass spectrometry unit. Within this unit, the itraconazole compound is separated, and the mass spectrometer measures the mass-to-charge ratio of the ions by exposing them to a magnetic or electric field, allowing for sorting based on mass. The quantity of sorted ions is then quantified, and when two mass spectrometry detectors are employed, the selected molecules undergo additional fragmentation analysis. The resulting mass-to-charge data is graphically represented by a computer, which ultimately determines the concentration of itraconazole in the sample.
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The use of itraconazole is indicated for the treatment of various fungal infections, specifically targeting the following conditions:
The procedure for measuring therapeutic levels of itraconazole involves several critical steps to ensure accurate assessment of systemic absorption and potential toxicity. The process begins with the collection of a serum sample from the patient, which is then prepared by mixing the analyte in a suitable solvent. This mixture is subsequently pumped through a chromatographic column at high pressure. The movement of the liquid is facilitated by a stream of helium or nitrogen gas, which acts as the carrier gas. As the sample travels through the column, it is nebulized into a fine spray and ionized, allowing the ions to be transferred to the mass spectrometry unit. Within this unit, the itraconazole compound is separated based on its mass-to-charge ratio. The mass spectrometer employs either a magnetic or electric field to sort the ions according to their mass. The quantity of sorted ions is then quantified, providing a measurement of the concentration of itraconazole in the sample. In cases where the active metabolite, hydroxyitraconazole, is also measured, the analysis may involve further fragmentation of the selected molecules using two mass spectrometry detectors. This additional step enhances the specificity of the measurement. Finally, the mass-to-charge data is graphically represented by a computer, which calculates and determines the concentration of itraconazole and its metabolite in the serum sample.
Post-procedure care following the measurement of itraconazole levels typically involves monitoring the patient for any signs of toxicity, especially if therapeutic levels are found to be elevated. Patients should be informed about potential symptoms of toxicity, such as blurred or double vision, tinnitus, and urinary incontinence. It is essential for healthcare providers to review the results of the serum level tests and adjust the itraconazole dosage as necessary to maintain therapeutic levels within the recommended range. Continuous assessment of the patient's response to treatment and any adverse effects is crucial for ensuring safe and effective management of fungal infections.
| Short Descr | DRUG ASSAY ITRACONAZOLE | Medium Descr | DRUG ASSAY ITRACONAZOLE | Long Descr | Itraconazole | 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) | none | MUE | 1 |
| 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. | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption |
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| 2021-01-01 | Added | Code added. |
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