How To Use CPT Code 0069U

CPT 0069U describes a proprietary laboratory analysis (PLA) code for the miR–31now™ test offered by GoPath Laboratories. This test measures the expression of miR–31–3p in formalin-fixed paraffin-embedded colon cancer tissue and uses an algorithm to assign an expression score. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0069U.

1. What is CPT Code 0069U?

CPT 0069U is a proprietary laboratory analysis (PLA) code that applies to the miR–31now™ test offered by GoPath Laboratories. This test measures the expression of miR–31–3p in formalin-fixed paraffin-embedded colon cancer tissue and uses an algorithm to assign an expression score. The test is designed to guide treatment therapy for patients with metastatic colorectal cancer (mCRC) who may benefit from therapy targeting epidermal growth factor receptor (EGFR).

2. Official Description

The official description of CPT code 0069U is: ‘Oncology (colorectal), microRNA, RT-PCR expression profiling of miR-31-3p, formalin-fixed paraffin-embedded tissue, algorithm reported as an expression score.’

3. Procedure

1. The lab analyst processes a formalin-fixed, paraffin-embedded (FFPE) tumor sample from a patient with metastatic colorectal cancer.
2. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) is used to measure the expression of miR-31-3p in the tumor sample.
3. An algorithmic analysis is performed using the test results and patient clinical data to report an expression score indicating the level of miR-31 expression.

4. Qualifying circumstances

CPT code 0069U is typically ordered for patients with wild-type RAS metastatic colon cancer (mCRC) who may benefit from therapy targeting EGFR, such as cetuximab and panitumumab. The test measures the expression of miR-31-3p, which has been found to impact the sensitivity of mCRC to anti-EGFR therapy. Low miR-31-3p expression indicates potential benefit from initial cetuximab treatment, while high miR-31-3p expression suggests no difference in outcome for anti-EGFR or anti-VEGF treatment.

5. When to use CPT code 0069U

CPT code 0069U should be used when ordering the miR–31now™ test from GoPath Laboratories to assess the expression of miR-31-3p in formalin-fixed paraffin-embedded colon cancer tissue. This test is specifically designed for patients with metastatic colorectal cancer (mCRC) who may benefit from therapy targeting EGFR.

6. Documentation requirements

To support a claim for CPT code 0069U, the following documentation is required:

• Documentation of the patient’s diagnosis of metastatic colorectal cancer
• Documentation of the need for miR-31-3p expression profiling
• Test results indicating the expression score assigned by the algorithm
• Patient clinical data used in the algorithmic analysis

7. Billing guidelines

When billing for CPT code 0069U, ensure that the test is performed by GoPath Laboratories for the miR–31now™ test. This code is a proprietary laboratory analysis (PLA) code and should not be reported with any other CPT code. Only report one unit of this code for a single specimen analyzed on a single date of service.

8. Historical information

CPT code 0069U was added to the Current Procedural Terminology system on October 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A patient with metastatic colorectal cancer undergoes the miR–31now™ test to assess the expression of miR-31-3p in their tumor tissue.
2. A physician orders the miR–31now™ test for a patient with wild-type RAS metastatic colon cancer to guide treatment decisions regarding therapy targeting EGFR.
3. A patient with metastatic colorectal cancer receives a high miR-31-3p expression score from the miR–31now™ test, indicating no difference in outcome for anti-EGFR or anti-VEGF treatment.
4. A clinician uses the miR–31now™ test to identify a patient with low miR-31-3p expression, suggesting potential benefit from initial cetuximab treatment.
5. A patient with metastatic colorectal cancer undergoes the miR–31now™ test to determine their miR-31-3p expression level and guide personalized treatment decisions.
6. A physician orders the miR–31now™ test for a patient with metastatic colorectal cancer to assess their miR-31-3p expression and tailor therapy accordingly.
7. A patient with wild-type RAS metastatic colon cancer undergoes the miR–31now™ test to determine their miR-31-3p expression level and guide treatment decisions regarding EGFR-targeted therapy.
8. A clinician uses the miR–31now™ test to assess the miR-31-3p expression in a patient’s tumor tissue and inform treatment choices for metastatic colorectal cancer.
9. A patient with metastatic colorectal cancer receives an expression score from the miR–31now™ test, indicating the level of miR-31-3p expression in their tumor tissue.
10. A physician orders the miR–31now™ test for a patient with metastatic colorectal cancer to evaluate their miR-31-3p expression and guide personalized treatment decisions.