CPT® Code 80440

Code deleted, see 84146

Official Description

Thyrotropin releasing hormone (TRH) stimulation panel; for hyperprolactinemia This panel must include the following: Prolactin (84146 x 3)

Common Language Description

The CPT® Code 80440 refers to a specific laboratory test known as the Thyrotropin releasing hormone (TRH) stimulation panel, which is utilized for the diagnosis and monitoring of hyperprolactinemia, a condition characterized by elevated levels of prolactin in the blood. Prolactin is a hormone produced by the pituitary gland that plays a crucial role in various physiological processes, including the stimulation of breast milk production, regulation of the immune system, and involvement in metabolism and blood clotting. Hyperprolactinemia can present with a range of symptoms depending on the gender of the patient. In women, it may lead to abnormal breast milk secretion, known as galactorrhea, as well as amenorrhea (the absence of menstruation) and infertility. In men, the condition often manifests as reduced libido and erectile dysfunction. The underlying causes of hyperprolactinemia can vary, with the most common being prolactinoma, a typically benign tumor of the anterior pituitary gland, the use of neuroleptic or antipsychotic medications, and primary hypothyroidism. The TRH stimulation test is designed to assess the body's response to thyrotropin-releasing hormone, which, when produced in excess, inhibits dopamine secretion. This inhibition results in increased prolactin secretion from the pituitary gland. Elevated prolactin levels can suppress the secretion of gonadotropic releasing hormone, leading to decreased production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by the ovaries and testes. For accurate results, the TRH stimulation test requires the patient to fast overnight, and involves the insertion of an intravenous line to facilitate blood sample collection and TRH administration.

1. Indications

The Thyrotropin releasing hormone (TRH) stimulation panel is indicated for the evaluation and management of hyperprolactinemia. This condition may present with various symptoms and is associated with several underlying causes. The following are the specific indications for performing this panel:

Abnormal Secretion of Breast Milk (Galactorrhea) - Women experiencing unexpected lactation may require testing to determine the underlying cause.
Amenorrhea - The absence of menstrual periods in women can be a symptom of elevated prolactin levels, warranting further investigation.
Infertility - Both men and women facing challenges with conception may be evaluated for hyperprolactinemia as a potential contributing factor.
Low Libido - In men, reduced sexual desire may indicate hormonal imbalances, including elevated prolactin levels.
Erectile Dysfunction - Men experiencing difficulties with erectile function may be assessed for hyperprolactinemia as part of their evaluation.

2. Procedure

The procedure for the TRH stimulation panel involves several critical steps to ensure accurate measurement of prolactin levels in response to TRH administration. The following outlines the procedural steps:

Step 1: Patient Preparation - The patient must fast overnight prior to the test to ensure that baseline prolactin levels are not influenced by recent food intake.
Step 2: Intravenous Line Insertion - An intravenous (IV) line is established to facilitate the administration of TRH and the collection of blood samples. This step is performed as a separately reportable procedure.
Step 3: Baseline Blood Sample Collection - A baseline blood sample is obtained from the IV line or through a separately reportable venipuncture to measure initial prolactin levels before TRH administration.
Step 4: TRH Administration - Thyrotropin-releasing hormone (TRH) is administered via IV push to stimulate the pituitary gland and assess its response.
Step 5: Post-Administration Blood Sample Collection - Additional blood samples are collected at 20-minute intervals following TRH administration to monitor changes in prolactin levels over time.
Step 6: Laboratory Testing - The collected serum or plasma samples are analyzed using a quantitative chemiluminescent immunoassay to determine the prolactin levels at each time point.

3. Post-Procedure

After the TRH stimulation test is completed, the patient may be monitored briefly to ensure there are no immediate adverse reactions to the TRH administration. The results of the prolactin level tests will be compiled and interpreted by the healthcare provider to assess the patient's hormonal status and determine the appropriate next steps in management. Patients may resume normal activities following the procedure, and any specific post-procedure care instructions will be provided by the healthcare team based on individual circumstances.

Short Descr	TRH STIMULATION PANEL
Medium Descr	THYROTROPIN RELEAS HORMONE HYPRPROLACTINEMIA
Long Descr	Thyrotropin releasing hormone (TRH) stimulation panel; for hyperprolactinemia This panel must include the following: Prolactin (84146 x 3)
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	9 - 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
APC Status Indicator	Items and Services Packaged into APC Rates
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	Not applicable/unspecified.
CCS Clinical Classification	235 - Other Laboratory