How To Use CPT Code 0092U

CPT 0092U describes a specific proprietary laboratory analysis (PLA) test called the REVEAL Lung Nodule Characterization test. This test is performed by MagArray, Inc. and is used to detect three protein biomarkers for lung cancer in blood plasma. The test utilizes magnetic nanosensor technology and an algorithm to calculate a risk score for the likelihood of malignancy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0092U.

1. What is CPT Code 0092U?

CPT 0092U is a proprietary laboratory analysis (PLA) code that applies to the REVEAL Lung Nodule Characterization test from MagArray, Inc. This test is designed to detect three protein biomarkers for lung cancer in blood plasma. By utilizing magnetic nanosensor technology and an algorithm, the test provides a risk score ranging from 0 to 100, indicating the likelihood of malignancy for indeterminate lung nodules in smokers.

2. Official Description

The official description of CPT code 0092U is: ‘Oncology (lung), three protein biomarkers, immunoassay using magnetic nanosensor technology, plasma, algorithm reported as risk score for likelihood of malignancy.’

3. Procedure

1. The lab analyst performs an immunoassay on a plasma specimen from a smoker with indeterminate pulmonary nodules suspicious for lung cancer.
2. The REVEAL technology, which incorporates magnetic nanosensors, is used to detect three protein biomarkers for lung cancer.
3. The lab analyst inputs the results of the immunoassay and the three clinical factors into an algorithm to calculate a risk score ranging from 0 to 100.
4. A score of 50 or higher indicates a higher probability that the pulmonary nodules are cancerous.
5. The test is not diagnostic for lung cancer but provides a risk assessment to help clinicians and patients decide on further diagnostic procedures, such as a lung biopsy or observation.

4. Qualifying circumstances

The REVEAL Lung Nodule Characterization test is ordered for patients who are 25 years of age or older, smokers, and have indeterminate pulmonary nodules suspicious for lung cancer. The test helps determine whether a lung biopsy should be performed or if a “watch and wait” approach is appropriate. It is important to note that the test is not diagnostic for lung cancer but provides a risk assessment based on the calculated risk score.

5. When to use CPT code 0092U

CPT code 0092U should be used when reporting the REVEAL Lung Nodule Characterization test from MagArray, Inc. This code should not be reported with any other CPT code, as it is specific to this proprietary test. It is important to ensure that the test is performed on a single specimen analyzed on a single date of service.

6. Documentation requirements

To support a claim for CPT code 0092U, the following documentation is required:

• Patient’s age and smoking history
• Indeterminate pulmonary nodules suspicious for lung cancer
• Results of the immunoassay for the three protein biomarkers
• Three clinical factors used in the algorithm
• Risk score calculated by the algorithm
• Explanation of the risk assessment and its implications for further diagnostic procedures

7. Billing guidelines

When billing for CPT code 0092U, ensure that the test is performed by MagArray, Inc. and that it is reported for the REVEAL Lung Nodule Characterization test. This code should not be reported with any other CPT code. It is important to check with the appropriate payer regarding the coverage and payment for specimen collection, as some payers may reimburse separately for this service.

8. Historical information

CPT code 0092U is a proprietary laboratory analysis (PLA) code that was added to the CPT code set to identify specific tests offered by MagArray, Inc. The code is unique to the REVEAL Lung Nodule Characterization test and has no historical changes or updates since its inclusion.

9. Examples

1. A 55-year-old smoker with indeterminate pulmonary nodules undergoes the REVEAL Lung Nodule Characterization test. The immunoassay detects elevated levels of the three protein biomarkers, and the algorithm calculates a risk score of 75, indicating a high likelihood of malignancy. Based on the test results, the clinician recommends a lung biopsy for further evaluation.
2. A 60-year-old smoker with indeterminate pulmonary nodules undergoes the REVEAL Lung Nodule Characterization test. The immunoassay shows normal levels of the three protein biomarkers, and the algorithm calculates a risk score of 35, indicating a low likelihood of malignancy. The clinician decides to monitor the nodules with regular imaging studies rather than performing a lung biopsy.
3. A 50-year-old non-smoker with indeterminate pulmonary nodules undergoes the REVEAL Lung Nodule Characterization test. The immunoassay detects elevated levels of the three protein biomarkers, and the algorithm calculates a risk score of 60, indicating an intermediate likelihood of malignancy. The clinician discusses the test results with the patient and recommends further diagnostic procedures to confirm the presence or absence of lung cancer.
4. A 65-year-old smoker with indeterminate pulmonary nodules undergoes the REVEAL Lung Nodule Characterization test. The immunoassay shows normal levels of the three protein biomarkers, and the algorithm calculates a risk score of 25, indicating a very low likelihood of malignancy. The clinician reassures the patient and advises regular follow-up imaging studies to monitor the nodules.
5. A 45-year-old smoker with indeterminate pulmonary nodules undergoes the REVEAL Lung Nodule Characterization test. The immunoassay detects elevated levels of the three protein biomarkers, and the algorithm calculates a risk score of 80, indicating a very high likelihood of malignancy. The clinician recommends immediate further diagnostic procedures, such as a lung biopsy, to confirm the presence of lung cancer.