CPT® Code 80424

Official Description

Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2)

Common Language Description

The CPT® Code 80424 refers to a specific laboratory test known as the glucagon tolerance panel, which is utilized primarily for the diagnosis and monitoring of pheochromocytoma. Pheochromocytoma is a rare type of neuroendocrine tumor that typically arises in the adrenal medulla, the inner part of the adrenal glands. This tumor originates from chromaffin cells, which are responsible for the production of catecholamines, including adrenaline (epinephrine) and noradrenaline (norepinephrine). These hormones play a crucial role in the body's response to stress, helping to regulate vital functions such as heart rate, blood pressure, and metabolism. The glucagon tolerance test is designed to assess the levels of catecholamines in the bloodstream, both at baseline and after the administration of glucagon, a hormone that stimulates the liver to release glucose into the bloodstream. The test begins with the insertion of an intravenous (IV) line, which is a separate procedure that must be reported independently. Following a resting period of at least 30 minutes in a supine position, a baseline blood sample is collected through the IV line to measure the fractionated catecholamines. Subsequently, a dose of glucagon (1 mg) is administered via IV push, and a second blood sample is taken two minutes later to evaluate the response of catecholamine levels to the glucagon injection. The analysis of the serum or plasma samples is performed using quantitative high-performance liquid chromatography, a sophisticated technique that allows for precise measurement of catecholamine concentrations. This test is particularly important as elevated levels of catecholamines can lead to various symptoms, including hypertension, tachycardia, and anxiety, which may occur intermittently and can significantly impact patient health.

1. Indications

The glucagon tolerance panel (CPT® Code 80424) is indicated for the diagnosis and monitoring of pheochromocytoma. This test is particularly relevant for patients exhibiting symptoms associated with elevated catecholamine levels, which may include:

Elevated Blood Pressure Persistent high blood pressure that may be difficult to control.
Rapid and Forceful Heartbeat Episodes of tachycardia that can occur suddenly.
Excessive Sweating Episodes of profuse sweating not related to physical activity or temperature.
Headaches Severe headaches that may be recurrent and unexplained.
Tremors Involuntary shaking or trembling, particularly in the hands.
Paleness Noticeable paleness of the skin, often associated with stress responses.
Shortness of Breath Difficulty breathing that may occur during episodes of catecholamine release.
Anxiety Feelings of anxiety or panic that may be linked to catecholamine surges.

2. Procedure

The glucagon tolerance test involves several critical procedural steps to ensure accurate measurement of catecholamine levels. The procedure begins with the insertion of an intravenous (IV) line, which is essential for administering glucagon and obtaining blood samples. This step is performed as a separate reportable procedure. Once the IV line is established, the patient is instructed to rest in a supine position for a minimum of 30 minutes. This resting period is crucial as it allows the body to stabilize before baseline measurements are taken.

Baseline Blood Sample Collection After the resting period, a baseline blood sample is drawn from the IV line. This sample is critical for measuring the initial levels of fractionated catecholamines in the bloodstream.
Administration of Glucagon Following the baseline sample collection, glucagon is administered via IV push at a dosage of 1 mg. Glucagon is a polypeptide hormone that stimulates the release of glucose and can provoke a response in catecholamine levels.
Post-Injection Blood Sample Collection Two minutes after the glucagon injection, a second blood sample is obtained from the IV line. This sample is analyzed to determine the levels of fractionated catecholamines in response to the glucagon administration.

The serum or plasma obtained from these samples is then subjected to quantitative high-performance liquid chromatography, a precise analytical technique that quantifies the concentration of catecholamines, providing essential data for the diagnosis and management of pheochromocytoma.

3. Post-Procedure

After the glucagon tolerance test is completed, patients may be monitored for any immediate reactions to the glucagon injection, although significant adverse effects are uncommon. It is important for healthcare providers to ensure that patients are stable before they leave the facility. Patients may experience temporary symptoms such as mild nausea or changes in blood pressure, which should be documented. Follow-up care may include discussing the results of the test with the patient and determining any further diagnostic or therapeutic steps based on the findings. Additionally, patients should be advised to report any unusual symptoms that may arise following the procedure.

Short Descr	GLUCAGON TOLERANCE PANEL
Medium Descr	GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA
Long Descr	Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2)
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	235 - Other Laboratory

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.