How To Use CPT Code 0113U

CPT 0113U describes a proprietary laboratory analysis (PLA) test called the MiPS (Mi-Prostate Score) test. This article will cover the description, official description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0113U?

CPT 0113U is a unique code that represents the MiPS (Mi-Prostate Score) test. This test is a proprietary laboratory analysis (PLA) test that uses RNA amplification and fluorescence-based detection to measure the levels of two genes, TMPRSS2-ERG and PCA3, in urine, as well as the PSA level in serum. These measurements are then entered into a proprietary algorithm to calculate a risk score for prostate cancer.

2. Official Description

The official description of CPT code 0113U is: ‘Oncology (prostate), measurement of PCA3 and TMPRSS2-ERG in urine and PSA in serum following prostatic massage, by RNA amplification and fluorescence-based detection, algorithm reported as risk score.’

3. Procedure

1. The MiPS test requires the collection of a urine specimen and a serum specimen after prostate massage.
2. The lab analyst performs various technical steps, including extracting nucleic acids, amplifying and stabilizing the quantity of nucleic acid, and detecting the target genes using RNA fluorescent probes.
3. The levels of TMPRSS2-ERG and PCA3 in the urine, as well as the PSA level in serum, are quantitatively measured.
4. These measurements are then entered into a proprietary algorithm that calculates a risk score for prostate cancer.

4. Qualifying circumstances

The MiPS test is ordered for patients with previously known high PSA scores to help determine whether further monitoring or a prostate biopsy is necessary. Elevated levels of TMPRSS2-ERG and PCA3 in the urine typically indicate the presence of prostate cancer.

5. When to use CPT code 0113U

CPT code 0113U should be used when the MiPS test is performed. This code should not be reported with any other CPT code.

6. Documentation requirements

To support a claim for CPT code 0113U, the following documentation is required:

• Order for the MiPS test
• Date of service
• Results of the urine and serum measurements
• Proprietary risk score calculated by the algorithm

7. Billing guidelines

When billing for CPT code 0113U, ensure that the MiPS test is performed and that the documentation requirements are met. This code should not be reported with any other CPT code. It is important to check with the appropriate payer regarding payment for specimen collection.

8. Historical information

CPT code 0113U was added to the Current Procedural Terminology system on October 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient with a previously known high PSA score undergoes the MiPS test to determine the risk of prostate cancer.
2. A clinician orders the MiPS test for a patient with elevated levels of TMPRSS2-ERG and PCA3 in the urine to assess the likelihood of prostate cancer.
3. A patient with a high PSA score undergoes the MiPS test, which reveals a low risk score for prostate cancer, indicating that further monitoring is sufficient.
4. A urologist orders the MiPS test for a patient with suspected prostate cancer to aid in the decision-making process for a prostate biopsy.
5. A patient with a history of prostate cancer undergoes the MiPS test to monitor the risk of recurrence.
6. A primary care physician orders the MiPS test for a patient with persistent urinary symptoms and an elevated PSA level to assess the likelihood of prostate cancer.
7. A patient with a family history of prostate cancer undergoes the MiPS test to determine their individual risk of developing the disease.
8. A urologist orders the MiPS test for a patient with an indeterminate prostate biopsy result to aid in the diagnosis of prostate cancer.
9. A patient with a high PSA score undergoes the MiPS test, which reveals a high risk score for prostate cancer, prompting further diagnostic investigations.
10. A clinician orders the MiPS test for a patient with suspected prostate cancer to assess the need for immediate treatment.