How To Use CPT Code 0058U

CPT 0058U describes the detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T antigen) in serum. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0058U?

CPT 0058U can be used to detect and quantify antibodies to the Merkel cell (MC) polyomavirus small T (sT) antigen/oncoprotein in serum. This test is specifically designed to identify one of the major causative agents for tumorigenesis and tumor maintenance in Merkel cell carcinoma (MCC), a highly aggressive and potentially fatal neuroendocrine skin cancer.

2. Official Description

The official description of CPT code 0058U is: ‘Oncology (Merkel cell carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T antigen), serum, quantitative.’

3. Procedure

1. The lab analyst performs the technical steps to quantitate antibodies to the Merkel cell polyomavirus small T antigen (sTAg/oncoprotein in a serum specimen.
2. Blood is centrifuged to separate out the serum.
3. The analyst uses fluorescence and multiplex bead technology to perform the test.
4. A piece of the MC oncoprotein is attached to beads, which immobilizes it.
5. The serum specimen is exposed to the oncoprotein, allowing any antibodies present to attach to it.
6. All other proteins are washed away, leaving only the antibodies attached to the oncoprotein.
7. A fluorescent probe is applied to the beads, and the analyst examines them.
8. The presence of antibodies attached to the oncoprotein indicates recent presence of tumor as opposed to simply exposure.

4. Qualifying circumstances

This test is ordered by clinicians for patients with Merkel cell carcinoma to detect early recurrence. Approximately 50% of patients with MCC produce antibodies to the oncoproteins, and the levels of these antibodies decline over time but increase rapidly with recurrent disease. Patients who produce these antibodies have a better prognosis, while those who do not are at higher risk for developing a recurrence and have a poorer prognosis.

5. When to use CPT code 0058U

CPT code 0058U should be used when there is a clinical need to detect and quantify antibodies to the Merkel cell polyomavirus small T antigen in serum. This test is specifically designed for patients with Merkel cell carcinoma to monitor for early recurrence. It should not be used for any other purposes or conditions.

6. Documentation requirements

To support a claim for CPT code 0058U, the following documentation is required:

• Indication for the test, such as a diagnosis of Merkel cell carcinoma
• Date of the test
• Results of the test, including the quantitative measurement of antibodies to the oncoprotein
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0058U, ensure that the test is performed by the University of Washington’s Department of Laboratory Medicine, as this code applies specifically to their proprietary test. Report one unit of this code for a single specimen analyzed on a single date of service. It is important to note that some payers may pay separately for the collection of the specimen, so it is advisable to check with the appropriate payer for their specific billing requirements.

8. Historical information

CPT code 0058U was added to the Current Procedural Terminology system on July 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A patient with a previous diagnosis of Merkel cell carcinoma undergoes the CPT 0058U test to monitor for early recurrence.
2. A clinician orders the CPT 0058U test for a patient who has completed treatment for Merkel cell carcinoma to assess their risk of recurrence.
3. A patient with suspected Merkel cell carcinoma undergoes the CPT 0058U test to aid in the diagnosis of the condition.
4. A patient with a history of Merkel cell carcinoma undergoes regular monitoring with the CPT 0058U test to detect any early signs of recurrence.
5. A clinician orders the CPT 0058U test for a patient with Merkel cell carcinoma to assess their response to treatment.
6. A patient with a family history of Merkel cell carcinoma undergoes the CPT 0058U test as a precautionary measure.
7. A clinician orders the CPT 0058U test for a patient with suspicious skin lesions to determine if they are indicative of Merkel cell carcinoma.
8. A patient with a previous diagnosis of Merkel cell carcinoma undergoes the CPT 0058U test to assess their long-term prognosis.
9. A clinician orders the CPT 0058U test for a patient with Merkel cell carcinoma to guide treatment decisions.
10. A patient with a history of Merkel cell carcinoma undergoes the CPT 0058U test to monitor the effectiveness of their current treatment regimen.