How To Use CPT Code 0114U

CPT 0114U describes a proprietary laboratory analysis (PLA) code for the EsoGuard™ test from Lucid Diagnostics. This test utilizes cytosine methylation analysis of esophageal cells obtained from a swallowed balloon device. The results are then input into an algorithm, which reports the likelihood for Barrett’s esophagus based on the presence or absence of VIM and CCNA1 methylation. This article will provide an overview of CPT code 0114U, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0114U?

CPT 0114U is a proprietary laboratory analysis (PLA) code that specifically applies to the EsoGuard™ test from Lucid Diagnostics. This test involves the analysis of esophageal cells obtained from a swallowed balloon device. The results of the analysis are then input into an algorithm, which provides a likelihood for the presence of Barrett’s esophagus based on the methylation status of VIM and CCNA1 genes.

2. Official Description

The official description of CPT code 0114U is: ‘Gastroenterology (Barrett’s esophagus), VIM and CCNA1 methylation analysis, esophageal cells, algorithm reported as likelihood for Barrett’s esophagus.’

3. Procedure

1. The patient swallows an encapsulated, expandable balloon with a textured surface in a vitamin pill-sized capsule attached to a catheter.
2. Once the capsule is in the stomach, the balloon is everted from the capsule, inflated, and gently withdrawn 3 to 6 cm back into the esophagus.
3. The balloon samples the luminal epithelial lining of the esophagus, collecting esophageal cells for analysis.
4. After sampling, the balloon is deflated and inverted back into the capsule.
5. The capsule is then extracted through the mouth and sent to a laboratory for DNA extraction.
6. In the laboratory, DNA is extracted from the surface of the balloon and subjected to cytosine methylation analysis at 31 genomic locations.
7. The methylation status of VIM and CCNA1 genes is determined using next-generation sequencing.
8. The results are input into an algorithm, which reports the likelihood for Barrett’s esophagus based on the presence or absence of VIM and CCNA1 methylation.

4. Qualifying circumstances

The EsoGuard™ test with CPT code 0114U is ordered by clinicians to aid in the diagnosis of nondysplastic and both low-grade and high-grade dysplastic Barrett’s esophagus, as well as adenocarcinoma of the esophagus and gastroesophageal junction. This test is specifically designed for patients with suspected Barrett’s esophagus, which is believed to be caused by chronic gastroesophageal reflux disease (GERD). The test analyzes the methylation status of VIM and CCNA1 genes, which are chemically modified in Barrett’s esophagus.

5. When to use CPT code 0114U

CPT code 0114U should be used when ordering the EsoGuard™ test from Lucid Diagnostics for patients suspected of having Barrett’s esophagus. This test provides valuable information for the diagnosis of nondysplastic and dysplastic Barrett’s esophagus, as well as adenocarcinoma of the esophagus and gastroesophageal junction. It is important to note that this code should only be used for the specific proprietary test and should not be reported with any other CPT code.

6. Documentation requirements

To support a claim for CPT code 0114U, the following documentation is required:

• Indication for ordering the EsoGuard™ test
• Date of the test
• Results of the cytosine methylation analysis for VIM and CCNA1 genes
• Reported likelihood for Barrett’s esophagus based on the algorithm
• Signature of the clinician ordering the test

7. Billing guidelines

When billing for CPT code 0114U, it is important to ensure that the test is performed by Lucid Diagnostics using the EsoGuard™ test. This code should not be reported with any other CPT code. It is also recommended to check with the appropriate payer regarding separate reimbursement for specimen collection. Additionally, only report one unit of this code for a single specimen analyzed on a single date of service.

8. Historical information

CPT code 0114U was added to the Current Procedural Terminology system on October 1, 2019. There have been no updates or changes to this code since its addition.

9. Examples

1. A gastroenterologist orders the EsoGuard™ test for a patient with chronic GERD to assess the likelihood of Barrett’s esophagus based on the methylation status of VIM and CCNA1 genes.
2. A primary care physician suspects Barrett’s esophagus in a patient with persistent acid reflux symptoms and orders the EsoGuard™ test to aid in the diagnosis.
3. A gastroenterology specialist orders the EsoGuard™ test for a patient with a family history of Barrett’s esophagus to assess their risk of developing the condition.
4. An oncologist orders the EsoGuard™ test for a patient with high-grade dysplasia in the esophagus to determine the likelihood of Barrett’s esophagus and guide further treatment decisions.
5. A gastroenterologist orders the EsoGuard™ test for a patient with a history of GERD and recurring esophageal ulcers to evaluate the presence of Barrett’s esophagus.
6. A primary care physician orders the EsoGuard™ test for a patient with long-standing GERD symptoms and a previous diagnosis of esophagitis to assess the likelihood of Barrett’s esophagus.
7. A gastroenterology specialist orders the EsoGuard™ test for a patient with a history of GERD and a family history of esophageal cancer to evaluate their risk of developing Barrett’s esophagus.
8. An oncologist orders the EsoGuard™ test for a patient with a known diagnosis of Barrett’s esophagus to monitor disease progression and guide treatment decisions.
9. A primary care physician orders the EsoGuard™ test for a patient with persistent heartburn symptoms and a strong family history of Barrett’s esophagus to assess their risk of developing the condition.
10. A gastroenterologist orders the EsoGuard™ test for a patient with a previous diagnosis of low-grade dysplasia in the esophagus to determine the likelihood of progression to high-grade dysplasia or adenocarcinoma.