How To Use CPT Code 0026U

CPT 0026U describes a specific laboratory test for oncology (thyroid) using next-generation sequencing of DNA and mRNA of 112 genes. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0026U?

CPT 0026U can be used to describe a laboratory test for oncology (thyroid) that utilizes next-generation sequencing of DNA and mRNA of 112 genes. This test is performed on a fine needle aspirate of a thyroid nodule and provides algorithmic analysis reported as a categorical result, indicating either a “Positive, high probability of malignancy” or a “Negative, low probability of malignancy.”

2. Official Description

The official description of CPT code 0026U is: ‘Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result (“Positive, high probability of malignancy” or “Negative, low probability of malignancy”).’

3. Procedure

1. The laboratory analyst performs the CPT 0026U test on a fine needle aspiration (FNA) sample of a thyroid nodule.
2. The test utilizes next-generation sequencing of DNA and mRNA of 112 genes to detect genetic changes, including mutations, gene fusions, gene expression alterations, and copy number variations.
3. An algorithmic analysis is performed on the detected genetic alterations to determine the test result, which is reported as a categorical result indicating either a “Positive, high probability of malignancy” or a “Negative, low probability of malignancy.”

4. Qualifying circumstances

CPT 0026U is typically ordered by clinicians to determine the probability of thyroid cancer and guide patient management for individuals suspected of having thyroid cancer. The test can be used for patients with thyroid nodules, and the fine needle aspirate sample must be suitable for analysis.

5. When to use CPT code 0026U

CPT code 0026U should be used when a clinician orders the specific laboratory test for oncology (thyroid) using next-generation sequencing of DNA and mRNA of 112 genes. It is important to ensure that the test is performed on a fine needle aspirate of a thyroid nodule and that the algorithmic analysis is reported as a categorical result.

6. Documentation requirements

To support a claim for CPT 0026U, the documentation should include:

• Indication for ordering the test, such as suspicion of thyroid cancer
• Details of the fine needle aspirate sample used for the test
• Results of the algorithmic analysis, reported as a categorical result
• Date of service and the performing laboratory

7. Billing guidelines

When billing for CPT 0026U, ensure that the test is performed on a fine needle aspirate of a thyroid nodule and that the algorithmic analysis is reported as a categorical result. It is important to follow the specific guidelines provided by payers and to report the test with the appropriate diagnosis codes and modifiers, if required.

8. Historical information

CPT 0026U was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders CPT 0026U for a patient with a suspicious thyroid nodule to determine the probability of malignancy based on genetic analysis.
2. A fine needle aspirate sample from a thyroid nodule is sent for CPT 0026U testing, and the algorithmic analysis reports a “Positive, high probability of malignancy” result.
3. A patient with a thyroid nodule undergoes CPT 0026U testing, and the algorithmic analysis reports a “Negative, low probability of malignancy” result, providing reassurance and guiding further management decisions.
4. Based on clinical suspicion, a clinician orders CPT 0026U for a patient with a thyroid nodule, and the test results confirm a “Positive, high probability of malignancy,” leading to prompt intervention.
5. A fine needle aspirate sample from a thyroid nodule is analyzed using CPT 0026U, and the algorithmic analysis indicates a “Negative, low probability of malignancy,” allowing the patient to avoid unnecessary invasive procedures.
6. A clinician utilizes CPT 0026U to assess the likelihood of thyroid cancer in a patient with a suspicious thyroid nodule, and the test results provide valuable information for treatment planning.
7. CPT 0026U is ordered for a patient with a thyroid nodule, and the algorithmic analysis reports a “Positive, high probability of malignancy,” prompting further diagnostic evaluation and intervention.
8. A fine needle aspirate sample is tested using CPT 0026U, and the algorithmic analysis indicates a “Negative, low probability of malignancy,” providing reassurance and avoiding unnecessary interventions.
9. Based on clinical suspicion, a clinician orders CPT 0026U for a patient with a thyroid nodule, and the test results confirm a “Positive, high probability of malignancy,” guiding the appropriate management approach.
10. A patient with a thyroid nodule undergoes CPT 0026U testing, and the algorithmic analysis reports a “Negative, low probability of malignancy,” allowing for a conservative approach and close monitoring.