How To Use CPT Code 0103U

CPT 0103U describes the genomic sequence analysis panel for hereditary ovarian cancer. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0103U?

CPT 0103U can be used to describe the genomic sequence analysis panel for hereditary ovarian cancer. This code is used when a combination of NGS, Sanger, MLPA, and array CGH techniques are utilized to analyze a patient’s genomic sequence. The analysis includes mRNA analytics to resolve variants of unknown significance when indicated. The panel consists of 24 genes for sequencing and deletion/duplication, as well as the EPCAM gene for deletion/duplication analysis only.

2. Official Description

The official description of CPT code 0103U is: ‘Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with mRNA analytics to resolve variants of unknown significance when indicated (24 genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only]).’

3. Procedure

1. The lab analyst performs a genomic sequencing analysis panel using a patient specimen, such as blood.
2. The analysis involves utilizing a combination of NGS, Sanger, MLPA, and array CGH techniques.
3. The 24 genes associated with hereditary ovarian cancer are sequenced for both coding domains and promoter regions.
4. NGS is used to detect specific gene variants, such as inversion of coding exons and the BRCA2 Portuguese founder mutation.
5. Additional Sanger sequencing, MLPA, and array CGH with mRNA analytics are performed to resolve variants of unknown significance when indicated.
6. Deletion/duplication analysis is performed on all 25 genes, including EPCAM.

4. Qualifying circumstances

CPT 0103U is used for patients with hereditary ovarian cancer or hereditary endometrial cancer. The test analyzes a combination of 24 genes for sequencing and deletion/duplication, as well as the EPCAM gene for deletion/duplication analysis only. The test is ordered by clinicians to guide medical management and determine the need for further diagnostic procedures. It helps identify and manage the risks for endometrial cancer and other hereditary cancers.

5. When to use CPT code 0103U

CPT code 0103U should be used when performing the genomic sequence analysis panel for hereditary ovarian cancer. It should not be reported with any other CPT code. This code is specific to the OvaNext® test from Ambry Genetics®, and one unit should be reported for each specimen analyzed on a single date of service.

6. Documentation requirements

To support a claim for CPT code 0103U, the following documentation is required:

• Patient’s diagnosis of hereditary ovarian cancer or hereditary endometrial cancer
• Details of the genomic sequence analysis panel performed, including the combination of NGS, Sanger, MLPA, and array CGH techniques
• Date of service and specimen analyzed
• Results of the analysis, including any variants of unknown significance resolved through mRNA analytics
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 0103U, ensure that the test is performed by the appropriate lab and for the specific proprietary test, OvaNext® from Ambry Genetics®. Report one unit of this code for each specimen analyzed on a single date of service. Some payers may also separately reimburse for specimen collection, so it is important to check with the appropriate payer for their specific guidelines.

8. Historical information

CPT code 0103U is a Proprietary Laboratory Analyses (PLA) code that was added to the CPT code set. It is specific to the OvaNext® test from Ambry Genetics®. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the genomic sequence analysis panel for hereditary ovarian cancer using a patient’s blood specimen.
2. An oncologist ordering the OvaNext® test for a patient with a family history of hereditary ovarian cancer to guide medical management.
3. A patient undergoing the genomic sequence analysis panel to identify and manage the risks for hereditary endometrial cancer.
4. A lab performing the combination of NGS, Sanger, MLPA, and array CGH techniques to analyze the 24 genes associated with hereditary ovarian cancer.
5. A clinician using the OvaNext® test results to determine the need for further diagnostic procedures for a patient with epithelial ovarian cancer.
6. A lab technician performing deletion/duplication analysis on the EPCAM gene as part of the genomic sequence analysis panel for hereditary ovarian cancer.
7. An oncology team utilizing the OvaNext® test to improve the possibility of identifying and managing the risks for other hereditary cancers.
8. A patient with hereditary ovarian cancer undergoing the genomic sequence analysis panel to guide personalized treatment options.
9. A lab analyst using mRNA analytics to resolve variants of unknown significance identified during the genomic sequence analysis panel.
10. A clinician ordering the OvaNext® test to assess the hereditary cancer risk for a patient planning to undergo prophylactic surgery.