CPT® Code 82104

Official Description

Alpha-1-antitrypsin; phenotype

Common Language Description

The CPT® Code 82104 refers to the laboratory test for Alpha-1-antitrypsin (A1A) phenotype. This test is crucial for measuring the levels and types of Alpha-1-antitrypsin, a protein synthesized in the liver and released into the bloodstream. Alpha-1-antitrypsin functions as a serum protease inhibitor, which means it plays a vital role in protecting body organs from damage caused by proteolytic enzymes. These enzymes, when unopposed by inhibitors like Alpha-1-antitrypsin, can lead to significant organ damage, particularly in the lungs, where they can contribute to conditions such as emphysema. The absence or deficiency of Alpha-1-antitrypsin is often genetic, and this test is particularly important for diagnosing early onset emphysema, especially in younger patients. Additionally, it is utilized in evaluating patients who present with persistent jaundice or other signs of liver dysfunction. The test for total Alpha-1-antitrypsin levels is reported under CPT® Code 82103, while CPT® Code 82104 specifically focuses on phenotype testing, which is performed when total levels are found to be lower than normal. This phenotype testing assesses both the quantity and type of Alpha-1-antitrypsin present in the blood, comparing it against established normal patterns. Identifying whether a patient has a homozygous or heterozygous phenotype of Alpha-1-antitrypsin deficiency is essential for guiding treatment, particularly since the deficiency can manifest in infancy or childhood. Blood samples for this test are obtained through a separately reportable venipuncture, and the serum is analyzed using isoelectric focusing, a technique that allows for the separation of proteins based on their isoelectric points.

1. Indications

The Alpha-1-antitrypsin phenotype test (CPT® Code 82104) is indicated for several specific clinical scenarios, particularly when there are concerns regarding Alpha-1-antitrypsin deficiency. The following conditions warrant the performance of this test:

Early Onset Emphysema - The test is performed to help diagnose the cause of emphysema that occurs at a younger age than typically expected.
Persistent Jaundice - It is indicated in patients exhibiting prolonged jaundice, which may suggest liver dysfunction.
Liver Dysfunction Symptoms - The test is also relevant for patients presenting with other symptoms indicative of liver issues, aiding in the assessment of liver health.

2. Procedure

The procedure for conducting the Alpha-1-antitrypsin phenotype test involves several key steps, ensuring accurate measurement and analysis of the protein levels in the blood. The following procedural steps are followed:

Step 1: Blood Sample Collection - A sample of blood is obtained from the patient through a venipuncture, which is a standard procedure for drawing blood. This step is crucial as it provides the serum needed for testing.
Step 2: Serum Preparation - Once the blood sample is collected, it is processed to separate the serum from the cellular components. This serum is what will be tested for Alpha-1-antitrypsin levels.
Step 3: Testing Methodology - The serum is then subjected to isoelectric focusing, a specialized laboratory technique that separates proteins based on their isoelectric points. This method allows for the identification of different types of Alpha-1-antitrypsin present in the sample.
Step 4: Analysis and Interpretation - After the isoelectric focusing process, the results are analyzed to determine the quantity and type of Alpha-1-antitrypsin. The findings are then compared to established normal patterns to identify any deficiencies or abnormalities.

3. Post-Procedure

After the Alpha-1-antitrypsin phenotype test is completed, the patient may experience minimal to no discomfort from the venipuncture. There are typically no specific post-procedure care requirements, but patients are advised to monitor the venipuncture site for any signs of excessive bleeding or infection. The results of the test will be reviewed by the healthcare provider, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the results. It is important for patients to understand the implications of their test results, especially in relation to potential genetic conditions and their impact on health.

Short Descr	ALPHA-1-ANTITRYPSIN PHENO
Medium Descr	ALPHA-1-ANTITRYPSIN PHENOTYPE
Long Descr	Alpha-1-antitrypsin; phenotype
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.
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.
91	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.
GA	Waiver of liability statement issued as required by payer policy, individual case
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GW	Service not related to the hospice patient's terminal condition
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ	Item or service expected to be denied as not reasonable and necessary
P2	A patient with mild systemic disease
Q4	Service for ordering/referring physician qualifies as a service exemption
QZ	Crna service: without medical direction by a physician