Clinical Context
A 45-year-old adult presents to an outpatient primary care clinic with symptoms of fatigue, cheilosis, and glossitis after a recent history of poor dietary intake and chronic alcohol use. The clinician orders a serum riboflavin (vitamin B2) assay to evaluate for riboflavin deficiency as part of a micronutrient workup. A phlebotomist collects a blood sample in the office or outpatient laboratory. The specimen is transported to the hospital or commercial clinical laboratory where a laboratory analyst performs the 84252 assay using appropriate analytic methods. Results are reported in the electronic medical record to the ordering provider, who integrates the value into nutritional assessment and management.
Typical site of service: outpatient clinic, physician office, outpatient laboratory, or hospital outpatient laboratory.
Typical patient scenario: evaluation of suspected riboflavin deficiency in patients with malnutrition, chronic alcohol use, malabsorption, or unexplained mucocutaneous symptoms; monitoring of nutritional status in chronic disease or after bariatric surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | When billing separately for the physician interpretation component if applicable. |
59 | Distinct procedural service | When this test is distinct and separate from another laboratory test on the same day that might be bundled.
90 | Reference (outside) laboratory; performed elsewhere | When the specimen is sent to an outside reference laboratory and billing must indicate outside performance.
91 | Repeat clinical diagnostic lab test | When the same test is repeated on the same day for monitoring or verification.
52 | Reduced services | When the test is partially reduced or not fully performed as described by the CPT due to clinical reasons.
53 | Discontinued procedure | When the specimen collection or test was discontinued prior to completion for valid clinical reasons.
59 | Distinct procedural service | When a separate, unrelated lab test is performed that would otherwise be considered bundled. (Listed to reflect common use for lab bundling scenarios.)
90 | Reference (outside) laboratory | When a contracted reference lab performs the analytic testing and the performing lab needs to indicate outside processing.
91 | Repeat test | For immediate repeats to confirm results after an initial abnormal value.
TC | Technical component | When billing only for the laboratory technical component (equipment, technician, reagents).
QK | CLIA waived test performed by non-laboratory trained personnel | When applicable in point-of-care scenarios under specific payer rules.
QX | CLIA-waived test performed by non-laboratory personnel (modifier for reporting in certain contracts) | When required by payer contract to indicate waived testing performed by non-lab staff.
GA | Waiver of liability statement on file | When a required Advance Beneficiary Notice or similar waiver is on file for Medicare/other payers.
90 | Outside lab performed | When the performing entity is an outside reference laboratory and charge reporting must indicate that fact.
| Taxonomy Code | Specialty | Notes |
|---|
207Q00000X | Pathology & Laboratory Medicine | Clinical laboratory directors and pathologists overseeing testing quality and interpretation. |
208D00000X | Diagnostic Radiology (Laboratory oversight) | Occasionally involved for laboratory director roles in diagnostic services (less common).
334600000X | General Practice | Primary care physicians ordering nutritional and deficiency testing.
207L00000X | Clinical Laboratory Technologist/Technician | Personnel who perform the 84252 analytic assay in the laboratory.
363L00000X | Clinical Nutritionist | Dietitians and clinical nutrition specialists who use results for nutritional management.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
E53.8 | Deficiency of other B vitamins | Includes riboflavin deficiency presentations leading to ordering of 84252. |
E46 | Unspecified protein-calorie malnutrition | Malnutrition increases risk for multiple micronutrient deficiencies, including riboflavin.
F10.20 | Alcohol dependence, uncomplicated | Chronic alcohol use predisposes to poor intake and malabsorption of B vitamins.
K90.0 | Celiac disease | Malabsorption disorders can cause deficiencies in water-soluble vitamins such as riboflavin.
E63.9 | Nutritional deficiency, unspecified | General code used when micronutrient deficiency suspected but not yet specified.
Z13.220 | Encounter for screening for nutritional and metabolic disorders | Screening contexts where a riboflavin assay may be ordered.
Z91.410 | Personal history of bariatric surgery | Post-bariatric patients are at risk for vitamin deficiencies and may have periodic monitoring including riboflavin.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
80053 | Comprehensive metabolic panel | Often ordered alongside 84252 to assess overall metabolic and nutritional status. |
83020 | Hemoglobin; glycosylated (A1c) | Common concurrent test in patients with chronic disease impacting nutrition; not directly related but frequently ordered in metabolic workups.
82728 | Thiamine (vitamin B1) assay | Other B-vitamin assays commonly ordered together when evaluating suspected multiple vitamin deficiencies.
84436 | Thyroid stimulating hormone (TSH) | Ordered in fatigue workups to evaluate alternative causes of symptoms that may accompany nutritional deficiencies.
85025 | Complete blood count (CBC) with automated differential | Routinely ordered with vitamin assays to assess anemia or hematologic effects of nutritional deficiencies.
82746 | Pyridoxine (vitamin B6) assay | Frequently performed with riboflavin testing when a B-vitamin deficiency panel is indicated.