How To Use CPT Code 0091U

CPT 0091U describes a specific laboratory test used for oncology (colorectal) screening. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0091U.

1. What is CPT Code 0091U?

CPT 0091U is a proprietary laboratory analysis (PLA) code that applies to a unique lab test called the FirstSightCRC™ test from CellMax Life. This test isolates and analyzes circulating tumor cells (CTCs) and cell-free DNA from a whole blood specimen to determine the presence of adenoma or cancer. The results of the test are reported as either positive or negative for adenoma or cancer.

2. Official Description

The official description of CPT code 0091U is: ‘Oncology (colorectal) screening, cell enumeration of circulating tumor cells, utilizing whole blood, algorithm, for the presence of adenoma or cancer, reported as a positive or negative result.’

3. Procedure

1. The lab analyst analyzes a whole blood specimen using the FirstSightCRC™ test from CellMax Life.
2. The test utilizes a proprietary CMx circulating tumor cell (CTC) platform with a circulating tumor DNA-based liquid biopsy panel.
3. The test identifies the presence of precancerous and cancerous cells indicative of colon adenomas or colorectal cancer.
4. The test uses a patented microfluidic chip technology to capture high-affinity colorectal cancer (CRC) antibodies circulating in the blood.
5. The captured cells are washed away, leaving only the desired cells bound to the chip.
6. An air-foam technology releases the captured cells from the chip for further analysis.
7. The test detects six types of analytes, including genomic mutations, microsatellite instability, and CTCs.
8. The results of the test are reported as positive or negative for the presence of adenoma or cancer.

4. Qualifying circumstances

CPT code 0091U is ordered by clinicians for early detection of colorectal cancer in patients who may not be amenable to colonoscopy. The test is specifically designed to identify the presence of adenoma or cancer cells in the blood. Adenomas are benign tumors of glandular structures that may evolve into malignant tumors, making them precancerous. The test utilizes an algorithmic analysis to provide diagnostic or prognostic information about treatment options or disease outcomes.

5. When to use CPT code 0091U

CPT code 0091U should be used when ordering the FirstSightCRC™ test from CellMax Life for oncology (colorectal) screening. It is important to note that this code is specific to the proprietary test and should not be reported with any other CPT code. Additionally, Medicare does not provide payment for this code in CY 2020.

6. Documentation requirements

To support a claim for CPT code 0091U, the following documentation is required:

• Order for the FirstSightCRC™ test from CellMax Life
• Date of service
• Results of the test reported as positive or negative for adenoma or cancer

7. Billing guidelines

When billing for CPT code 0091U, ensure that the test is performed by CellMax Life for the FirstSightCRC™ test. Report one unit of this code for a single specimen analyzed on a single date of service. Some payers may provide separate payment for the collection of the specimen, so it is important to check with the appropriate payer. It is also important to note that Medicare does not provide payment for this code in CY 2020.

8. Historical information

CPT code 0091U is a proprietary laboratory analysis (PLA) code that was added to the CPT code set to identify the FirstSightCRC™ test from CellMax Life. It is a unique code specific to this test and takes precedence over the usual 8 thousand series codes for laboratory/pathology. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders the FirstSightCRC™ test from CellMax Life for a patient who is not amenable to colonoscopy. The test results come back negative for the presence of adenoma or cancer.
2. A patient with a family history of colorectal cancer undergoes the FirstSightCRC™ test from CellMax Life. The test results come back positive for the presence of adenoma cells.
3. A patient presents with symptoms of colorectal cancer and the clinician orders the FirstSightCRC™ test from CellMax Life. The test results come back positive for the presence of cancer cells.
4. A patient who is unable to undergo colonoscopy due to medical reasons undergoes the FirstSightCRC™ test from CellMax Life. The test results come back negative for the presence of adenoma or cancer.
5. A clinician orders the FirstSightCRC™ test from CellMax Life as part of routine oncology screening for a patient. The test results come back positive for the presence of adenoma cells.
6. A patient with a history of colorectal cancer undergoes the FirstSightCRC™ test from CellMax Life for surveillance purposes. The test results come back negative for the presence of cancer cells.
7. A patient with a family history of colon adenomas undergoes the FirstSightCRC™ test from CellMax Life. The test results come back positive for the presence of adenoma cells.
8. A clinician orders the FirstSightCRC™ test from CellMax Life for a patient with suspected colorectal cancer. The test results come back negative for the presence of cancer cells.
9. A patient with a known genetic mutation associated with colorectal cancer undergoes the FirstSightCRC™ test from CellMax Life for monitoring purposes. The test results come back positive for the presence of cancer cells.
10. A clinician orders the FirstSightCRC™ test from CellMax Life for a patient who is unable to undergo colonoscopy due to personal reasons. The test results come back negative for the presence of adenoma or cancer.