How To Use CPT Code 0012M

CPT 0012M describes the mRNA gene expression profiling for urothelial carcinoma using a standardized algorithmic analysis. This article will cover the description, official definition, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0012M?

CPT 0012M can be used to perform mRNA gene expression profiling for urothelial carcinoma. This test involves analyzing the activity of five specific genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2) using real-time quantitative PCR. The results are then processed through an algorithmic analysis to determine a risk score for the presence of urothelial carcinoma, such as bladder cancer.

2. Official Description

The official description of CPT code 0012M is: ‘Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm reported as a risk score for having urothelial carcinoma.’

3. Procedure

1. The lab analyst collects a urine specimen from the patient.
2. The lab analyst performs real-time quantitative PCR to measure the activity of the five specified genes in the urine sample.
3. The lab analyst converts the RNA in the specimen to DNA and amplifies it to make millions of copies.
4. The lab analyst uses fluorescence probes to detect and quantify the amplified DNA.
5. The lab analyst inputs the test results and patient information into a computer program that performs an algorithmic analysis.
6. The computer program generates a risk score for the presence of urothelial carcinoma based on the gene expression profiling results.

4. Qualifying circumstances

CPT 0012M is typically ordered by clinicians to assess the likelihood of urothelial carcinoma in patients presenting with blood in the urine. The test is not limited to testing for a specific condition and can be used to evaluate the risk of bladder cancer. It is important to note that this test should only be performed by a qualified lab analyst using a standardized algorithmic analysis.

5. When to use CPT code 0012M

CPT code 0012M should be used when a clinician orders mRNA gene expression profiling for urothelial carcinoma using the specified five genes and algorithmic analysis. This code is appropriate for assessing the risk of urothelial carcinoma in patients with symptoms such as blood in the urine. It is important to follow the specific guidelines and criteria for using this code to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT code 0012M, the lab analyst must document the following information:

• Patient’s clinical presentation and symptoms
• Details of the mRNA gene expression profiling test performed, including the specific genes analyzed
• Results of the algorithmic analysis and the reported risk score for urothelial carcinoma
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0012M, ensure that the test is performed by a qualified lab analyst using the specified genes and algorithmic analysis. It is important to follow the specific guidelines and criteria for reporting this code accurately. Do not separately report the technical lab tests or specific gene assays, as CPT code 0012M includes all the underlying lab tests. If there is no specific Category I or administrative code for a given MAAA test, use the unlisted MAAA code, 81599. Make sure to distinguish between CPT codes 0012M and 0013M for urothelial carcinoma testing.

8. Historical information

CPT code 0012M was added to the Current Procedural Terminology system on April 1, 2018. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performing mRNA gene expression profiling for urothelial carcinoma using the specified five genes and algorithmic analysis.
2. A clinician ordering CPT code 0012M to assess the risk of bladder cancer in a patient with blood in the urine.
3. A lab analyst inputting the test results and patient information into a computer program for algorithmic analysis and reporting a risk score for urothelial carcinoma.
4. A patient undergoing mRNA gene expression profiling for urothelial carcinoma to determine the presence of bladder cancer.
5. A lab analyst documenting the results of the algorithmic analysis and reporting a risk score for urothelial carcinoma in a patient’s medical record.
6. A clinician using CPT code 0012M to evaluate the likelihood of urothelial carcinoma in a patient with urinary symptoms.
7. A lab analyst performing real-time quantitative PCR to measure the activity of the specified genes in a urine sample for urothelial carcinoma testing.
8. A clinician ordering mRNA gene expression profiling for urothelial carcinoma to assess the risk of bladder cancer in a patient with hematuria.
9. A lab analyst analyzing the gene expression profiling results and generating a risk score for urothelial carcinoma using the specified algorithm.
10. A patient undergoing mRNA gene expression profiling for urothelial carcinoma to determine the presence of bladder cancer based on the risk score reported.