CPT® Code 84490

Official Description

Trypsin; feces, quantitative, 24-hour collection

Common Language Description

The CPT® Code 84490 refers to a laboratory test that quantitatively measures the levels of trypsin in feces collected over a 24-hour period. Trypsin is a digestive enzyme produced by the pancreas, initially synthesized as an inactive precursor known as trypsinogen. This inactive form is secreted into the duodenum, where it is activated by the enzyme enteropeptidase. Once activated, trypsin plays a crucial role in the digestion of proteins by hydrolyzing them into smaller peptides and amino acids, which are then absorbed by the body. The measurement of fecal trypsin levels is significant for assessing exocrine pancreatic function. A decrease in trypsin levels in stool samples can indicate insufficient production by the pancreas, often associated with conditions such as chronic pancreatitis. Additionally, this test is particularly important in the evaluation of symptomatic newborns and infants for cystic fibrosis, as the disease can lead to the formation of mucous plugs in the pancreatic ducts, obstructing the secretion of trypsinogen into the small intestine. The quantitative nature of this test, as denoted by code 84490, allows for a more precise assessment of pancreatic function compared to semi-quantitative tests, such as those represented by CPT® Code 84488, which involves random stool specimens.

1. Indications

The test represented by CPT® Code 84490 is indicated for several specific clinical scenarios, particularly those related to pancreatic function and digestive health. The following conditions may warrant the performance of this test:

Exocrine Pancreatic Insufficiency - This condition occurs when the pancreas does not produce enough digestive enzymes, including trypsin, leading to malabsorption and digestive issues.
Chronic Pancreatitis - Patients with chronic pancreatitis may exhibit decreased levels of trypsin in their stool, indicating impaired pancreatic function.
Cystic Fibrosis Screening - In symptomatic newborns and infants, this test serves as a screening tool for cystic fibrosis, as the disease can obstruct pancreatic enzyme flow due to mucous plugs.

2. Procedure

The procedure for conducting the test associated with CPT® Code 84490 involves several key steps to ensure accurate collection and analysis of fecal trypsin levels. The following procedural steps are outlined:

Step 1: Collection of Fecal Sample - A 24-hour collection of feces is required for this test. Patients are instructed to collect all stool produced over a 24-hour period in a designated container, ensuring that the sample is preserved appropriately to maintain its integrity for testing.
Step 2: Laboratory Processing - Once the fecal sample is collected, it is sent to a laboratory where it undergoes processing. The sample is prepared for quantitative analysis, which may involve homogenization and dilution to facilitate accurate measurement of trypsin levels.
Step 3: Quantitative Measurement - The laboratory performs a quantitative analysis of the fecal trypsin levels using specific assays designed to measure the concentration of trypsin in the sample. This may involve enzymatic assays or immunoassays that provide precise quantification of trypsin present in the feces.

3. Post-Procedure

After the completion of the fecal trypsin test, there are several considerations for both the patient and the healthcare provider. Patients may be advised to follow up with their healthcare provider to discuss the results of the test. If the test indicates low levels of trypsin, further diagnostic evaluations may be necessary to determine the underlying cause of pancreatic insufficiency. Additionally, healthcare providers may recommend dietary modifications or enzyme replacement therapy based on the findings. It is important for patients to understand the implications of their test results and to engage in ongoing monitoring and management of their pancreatic health as needed.

Short Descr	ASSAY OF FECES FOR TRYPSIN
Medium Descr	TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION
Long Descr	Trypsin; feces, quantitative, 24-hour collection
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.