CPT® Code 82953

Code deleted, see 80434, 80435, 80428, 81000, 81002, 81005, 81099

Official Description

Glucose; tolbutamide tolerance test

Common Language Description

The CPT® Code 82953 refers to the glucose tolbutamide tolerance test, a laboratory procedure designed to assess the body's response to glucose following the administration of the sulfonylurea hypoglycemic agent, tolbutamide. This test is crucial for evaluating how effectively the pancreas produces insulin in response to glucose stimulation. Glucose, a simple sugar, is a primary energy source for the body's cells and is derived from various dietary sources as well as synthesized from glycogen stored in the liver and muscle tissues. The regulation of blood glucose levels is primarily managed by the pancreatic hormones insulin and glucagon. In this test, tolbutamide is administered intravenously, which stimulates the beta cells of the pancreas to secrete insulin. This response can be particularly useful in identifying insulin-producing tumors, as it provides insight into the pancreatic function and insulin secretion dynamics. The procedure involves the insertion of an intravenous line, which is a separately reportable procedure, and the collection of blood samples at specified intervals to monitor glucose levels over time. The test not only measures glucose but may also include insulin levels, providing a comprehensive view of the patient's metabolic response to the administered tolbutamide.

1. Indications

The glucose tolbutamide tolerance test is indicated for the following conditions:

Evaluation of Insulin Production This test is performed to assess the pancreatic beta cell function and the ability to produce insulin in response to glucose stimulation.
Detection of Insulin-Producing Tumors It is useful in identifying insulinomas or other conditions where abnormal insulin secretion occurs.
Assessment of Glucose Metabolism The test helps in understanding the body's glucose metabolism and insulin response, particularly in patients with suspected diabetes or other metabolic disorders.

2. Procedure

The glucose tolbutamide tolerance test involves several key procedural steps that ensure accurate measurement of glucose levels following tolbutamide administration.

Step 1: IV Line Insertion An intravenous (IV) line is established, which is a separately reportable procedure. This allows for the administration of tolbutamide and the collection of blood samples throughout the test.
Step 2: Baseline Blood Sample Collection A blood sample is obtained to measure the baseline glucose level. This can be done either from the IV line or through a separately reportable venipuncture, ensuring that initial glucose levels are accurately recorded before the administration of the drug.
Step 3: Administration of Tolbutamide Tolbutamide, at a dosage of 1 gram, is administered via IV push over a period of 2 minutes. This rapid administration is crucial for stimulating the pancreatic response.
Step 4: Post-Injection Blood Sample Collection Additional blood samples are collected at specified intervals of 20, 30, 60, and possibly 90 and 120 minutes after the injection. These samples are essential for monitoring the changes in glucose levels over time following the administration of tolbutamide.
Step 5: Laboratory Testing The collected plasma samples are tested for glucose using a quantitative enzymatic method. Additionally, blood insulin levels may be ordered and measured at the same intervals as glucose, utilizing a quantitative chemiluminescent immunoassay to provide a comprehensive analysis of the patient's metabolic response.

3. Post-Procedure

After the completion of the glucose tolbutamide tolerance test, patients may be monitored for any immediate reactions to the tolbutamide administration. It is important to observe the patient for signs of hypoglycemia or other adverse effects. The results of the glucose and insulin levels will be analyzed to determine the pancreatic function and insulin response. Patients may be advised on dietary considerations and follow-up appointments based on the test results. Any abnormal findings may necessitate further testing or intervention to address underlying metabolic issues.

Short Descr	GLUCOSE-TOLBUTAMIDE TEST
Medium Descr	GLUC TOLBUTAMIDE TOLERANCE TST
Long Descr	Glucose; tolbutamide tolerance test
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)	T1E - Lab tests - glucose
MUE	Not applicable/unspecified.
CCS Clinical Classification	233 - Laboratory - Chemistry and Hematology