How To Use CPT Code 0095U

CPT 0095U describes a proprietary laboratory analysis (PLA) test known as the Esophageal String Test™ (EST). This test is performed by Children’s Hospital Colorado Department of Pathology and Laboratory Medicine to evaluate the probability of active or inactive eosinophilic esophagitis (EoE) in patients. In this article, we will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0095U.

1. What is CPT Code 0095U?

CPT 0095U is a unique code used to identify the Esophageal String Test™ (EST) performed by Children’s Hospital Colorado Department of Pathology and Laboratory Medicine. This test utilizes enzyme-linked immunosorbent assays (ELISA) to analyze esophageal proteins collected from a swallowed string. It aims to detect two biomarkers, Eotaxin-3 (CCL26) and major basic protein (PRG2), which are associated with eosinophilic esophagitis (EoE). The results are reported as a probability of active or inactive EoE.

2. Official Description

The official description of CPT code 0095U is not provided in the available information.

3. Procedure

1. The Esophageal String Test™ (EST) begins with the patient swallowing a gelatin capsule containing a string.
2. The string, attached to the capsule, is deployed from the mouth, through the esophagus, stomach, and down to the small intestine.
3. After an hour, the string is gently pulled out, collecting esophageal proteins from the lining of the esophagus.
4. A lab analyst uses enzyme-linked immunosorbent assay (ELISA) techniques to evaluate the specimen for the presence of Eotaxin-3 (CCL26) and major basic protein (PRG2).
5. The analyst inputs the results, along with the patient’s clinical data, into an algorithm.
6. The algorithm calculates and reports the probability of active or inactive eosinophilic esophagitis (EoE) based on the antibody-antigen reactions.

4. Qualifying circumstances

CPT code 0095U is applicable for patients suspected of having eosinophilic esophagitis (EoE), an allergic inflammatory disease of the esophagus. The Esophageal String Test™ (EST) is ordered by clinicians to evaluate the probability of active or inactive EoE. The test specifically analyzes esophageal proteins for the presence of Eotaxin-3 (CCL26) and major basic protein (PRG2), which are biomarkers associated with EoE.

5. When to use CPT code 0095U

CPT code 0095U should be used when ordering the Esophageal String Test™ (EST) to assess the probability of active or inactive eosinophilic esophagitis (EoE) in patients suspected of having this condition. It is important to note that this code is specific to the proprietary test performed by Children’s Hospital Colorado Department of Pathology and Laboratory Medicine.

6. Documentation requirements

To support a claim for CPT code 0095U, the following documentation is typically required:

• Patient’s clinical data and suspected diagnosis of eosinophilic esophagitis (EoE)
• Details of the Esophageal String Test™ (EST) procedure, including the use of ELISA techniques
• Results of the ELISA analysis for Eotaxin-3 (CCL26) and major basic protein (PRG2)
• Reported probability of active or inactive EoE based on the algorithm

7. Billing guidelines

When billing for CPT code 0095U, it is important to ensure that the test is performed by Children’s Hospital Colorado Department of Pathology and Laboratory Medicine. As a proprietary laboratory analysis (PLA) code, this test takes precedence over other codes for laboratory/pathology. It is crucial to report only one unit of this code for a single specimen analyzed on a single date of service. Additionally, it is advisable to check with the appropriate payer for any specific requirements or guidelines related to deploying and retrieving the string used in the Esophageal String Test™ (EST).

8. Historical information

CPT code 0095U does not have any historical changes or updates mentioned in the available information.

9. Examples

1. A patient suspected of having eosinophilic esophagitis (EoE) undergoes the Esophageal String Test™ (EST) to determine the probability of active disease.
2. A clinician orders CPT code 0095U for a patient with symptoms suggestive of EoE to assess the likelihood of inactive eosinophilic esophagitis.
3. The Esophageal String Test™ (EST) is performed on a patient with a history of EoE to monitor the probability of disease recurrence.
4. A pediatric patient with suspected EoE undergoes the Esophageal String Test™ (EST) to evaluate the probability of active eosinophilic esophagitis.
5. A gastroenterologist orders CPT code 0095U for a patient with refractory esophageal symptoms to determine the likelihood of EoE.
6. A patient with a known diagnosis of EoE undergoes the Esophageal String Test™ (EST) to assess the probability of inactive disease after treatment.
7. A primary care physician orders CPT code 0095U for a patient with chronic esophageal symptoms to evaluate the probability of EoE.
8. The Esophageal String Test™ (EST) is performed on a patient with a family history of EoE to assess the likelihood of developing the condition.
9. A patient with suspected EoE undergoes the Esophageal String Test™ (EST) to determine the probability of active disease before initiating treatment.
10. A gastroenterologist orders CPT code 0095U for a patient with atypical esophageal symptoms to evaluate the likelihood of EoE as the underlying cause.