How To Use CPT Code 0072U
CPT 0072U describes the targeted sequence analysis of the CYP2D6 gene, specifically the CYP2D6-2D7 hybrid gene, which is involved in drug metabolism. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0072U.
1. What is CPT Code 0072U?
CPT 0072U can be used to identify specific mutations in the CYP2D6 gene, known as the CYP2D6-2D7 hybrid gene, which can impact the metabolism of certain drugs. This code is used for targeted sequence analysis of the gene to determine the patient’s genotype.
2. Official Description
The official description of CPT code 0072U is: ‘CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) gene analysis, targeted sequence analysis (i.e., CYP2D6-2D7 hybrid gene) (List separately in addition to code for primary procedure).’ This code is a proprietary laboratory analysis (PLA) code and should be used in conjunction with code 0070U.
3. Procedure
- The lab analyst performs technical steps to extract nucleic acids from a specimen, such as blood, and amplifies the targeted gene sequence using methods like polymerase chain reaction (PCR).
- The lab analyst then analyzes the amplified gene sequence to identify any mutations in the CYP2D6-2D7 hybrid gene.
- A single unit of CPT 0072U represents the analysis of a targeted gene sequence in the CYP2D6 gene for the specific mutation.
4. Qualifying circumstances
CPT 0072U is ordered as a secondary assay when the initial test, CPT 0070U, does not determine the patient’s CYP2D6 genotype. This analysis is important for patients receiving medications metabolized by CYP2D6, such as tamoxifen, codeine, tramadol, and certain antidepressants and antipsychotics.
5. When to use CPT code 0072U
CPT code 0072U should be used when the targeted sequence analysis of the CYP2D6-2D7 hybrid gene is necessary to determine the patient’s genotype. It is used as a follow-up test when the initial test, CPT 0070U, does not provide conclusive results.
6. Documentation requirements
To support a claim for CPT code 0072U, the documentation should include:
- Indication for the test and the reason for ordering it
- Details of the specimen used for analysis
- Date of service
- Results of the targeted sequence analysis
- Signature of the lab analyst performing the analysis
7. Billing guidelines
When billing for CPT code 0072U, ensure that the test is performed by a specific lab or manufacturer offering the proprietary test. Report one unit of this code for a single specimen analyzed on a single date of service. It must be reported in conjunction with a code for a primary procedure. Some payers may also separately reimburse for specimen collection.
8. Historical information
CPT code 0072U was added to the Current Procedural Terminology system on October 1, 2018. The code description was updated on January 1, 2020, to include the specific details of the targeted sequence analysis of the CYP2D6-2D7 hybrid gene.
9. Examples
- A patient is prescribed codeine for pain management, but the initial test, CPT 0070U, does not determine the patient’s CYP2D6 genotype. The targeted sequence analysis of the CYP2D6-2D7 hybrid gene, using CPT code 0072U, is performed to determine if the patient has any mutations that may affect codeine metabolism.
- A patient is undergoing treatment with tamoxifen for breast cancer, and the initial test, CPT 0070U, does not provide conclusive results for the patient’s CYP2D6 genotype. The targeted sequence analysis of the CYP2D6-2D7 hybrid gene, using CPT code 0072U, is ordered to determine if the patient has any mutations that may impact tamoxifen metabolism.
- A patient is prescribed an antidepressant medication, but the initial test, CPT 0070U, does not identify the patient’s CYP2D6 genotype. The targeted sequence analysis of the CYP2D6-2D7 hybrid gene, using CPT code 0072U, is performed to determine if the patient has any mutations that may affect the metabolism of the antidepressant.
