How To Use CPT Code 0013M

CPT 0013M describes the mRNA gene expression profiling for oncology (urothelial) using a standardized algorithmic analysis. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0013M?

CPT 0013M can be used to describe the mRNA gene expression profiling for oncology (urothelial) using a standardized algorithmic analysis. This code is used when a lab analyst performs technical lab tests for five specific genes and carries out an algorithmic analysis to report a risk score for recurrent urothelial carcinoma.

2. Official Description

The official description of CPT code 0013M 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 recurrent urothelial carcinoma.’

3. Procedure

1. The lab analyst performs technical lab tests using a specimen such as urine to quantitatively measure the activity of five specific genes.
2. The lab analyst converts the RNA from the specimen to DNA and amplifies the DNA to make millions of copies that can be detected by fluorescence probes.
3. The lab analyst inputs the test results and patient information into a computer program that analyzes the data using a specific algorithm.
4. The algorithmic analysis produces a risk score for the likelihood of recurrent urothelial carcinoma.

4. Qualifying circumstances

Patients eligible for CPT 0013M are those who have been treated for urothelial carcinoma and need to assess the likelihood of recurrence. This test is not limited to a specific condition and can be ordered by clinicians to help determine the risk of recurrence for their patients.

5. When to use CPT code 0013M

CPT code 0013M should be used when a lab analyst performs mRNA gene expression profiling for oncology (urothelial) using a standardized algorithmic analysis. It is important to note that this code includes all the technical lab tests and algorithmic analysis, so separate reporting of specific lab tests or gene assays is not necessary.

6. Documentation requirements

To support a claim for CPT 0013M, the lab analyst must document the following information:

• Patient information and relevant clinical data
• Test results for the five specific genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2)
• Details of the algorithmic analysis and the reported risk score

7. Billing guidelines

When billing for CPT 0013M, ensure that the lab analyst performs the mRNA gene expression profiling using the standardized algorithmic analysis. It is important to note that this code includes all the underlying lab tests, so separate reporting of specific lab tests or gene assays is not necessary. 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 0013M was added to the Current Procedural Terminology system on April 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing mRNA gene expression profiling for oncology (urothelial) using a standardized algorithmic analysis to report a risk score for recurrent urothelial carcinoma.
2. A clinician ordering CPT 0013M to assess the likelihood of recurrence for a patient who has been treated for urothelial carcinoma.
3. A lab analyst inputting test results and patient information into a computer program to analyze the data and generate a risk score for recurrent urothelial carcinoma.
4. A patient undergoing mRNA gene expression profiling for oncology (urothelial) to determine the risk of recurrence after treatment.
5. A lab analyst performing technical lab tests for five specific genes and carrying out an algorithmic analysis to report a risk score for recurrent urothelial carcinoma.
6. A clinician using CPT 0013M to help assess the likelihood of recurrence for a patient with a history of urothelial carcinoma.
7. A lab analyst quantitatively measuring the activity of five specific genes using a specimen such as urine for mRNA gene expression profiling.
8. A patient receiving a risk score for recurrent urothelial carcinoma based on mRNA gene expression profiling using a standardized algorithmic analysis.
9. A clinician ordering CPT 0013M to determine the risk of recurrence for a patient who has previously been treated for urothelial carcinoma.
10. A lab analyst performing an algorithmic analysis using patient data and test results to report a risk score for recurrent urothelial carcinoma.