How To Use CPT Code 0130U

CPT 0130U describes the targeted mRNA sequence analysis panel for hereditary colon cancer disorders. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0130U?

CPT 0130U can be used to describe the targeted mRNA sequence analysis panel for hereditary colon cancer disorders. This code is used when analyzing the mRNA sequence of 10 specific genes associated with conditions such as Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, and familial adenomatosis polyposis. The analysis helps improve the classification of genetic variants and guides medical management for patients with these disorders.

2. Official Description

The official description of CPT code 0130U is: ‘Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), targeted mRNA sequence analysis panel (APC, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, and TP53) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with other specific codes for genomic sequencing panels and primary procedures.

3. Procedure

1. The lab analyst performs targeted mRNA sequence analysis of 10 genes associated with hereditary colon cancer disorders.
2. The analysis is carried out using a high-throughput, qualitative, and quantitative sequence analysis technology.
3. The analysis focuses on genes such as APC, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, and TP53.
4. The analysis helps classify splicing variants and improves the understanding of genetic changes relevant to these disorders.
5. The results of the analysis assist clinicians in managing cancers associated with these genes and guiding medical interventions.

4. Qualifying circumstances

Patients eligible to receive CPT 0130U analysis are those with hereditary colon cancer disorders such as Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, and familial adenomatosis polyposis. The analysis is performed as an adjunct to DNA genetic testing to improve the classification of genetic variants and guide medical management. The analysis is typically ordered by clinicians to determine the need for earlier or more frequent colonoscopies, tailor treatments, and improve clinical outcomes for patients with these disorders.

5. When to use CPT code 0130U

CPT code 0130U should be used when performing targeted mRNA sequence analysis of the 10 genes associated with hereditary colon cancer disorders. It is important to use this code in addition to the primary procedure code for genomic sequencing panels. This code should not be reported with any other CPT code and should only be used for the specific proprietary test mentioned.

6. Documentation requirements

To support a claim for CPT 0130U, documentation should include:

• Indication of the patient’s hereditary colon cancer disorder
• Specific genes analyzed in the targeted mRNA sequence analysis
• Date of the analysis
• Results of the analysis, including classification of splicing variants
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 0130U, ensure that the analysis is performed by a lab offering the specific proprietary test mentioned. This code should be reported only in addition to the appropriate primary procedure code for genomic sequencing panels. It is important to check with the payer regarding separate payment for specimen collection. Use one unit of this code for a single specimen analyzed on a single date of service.

8. Historical information

CPT 0130U 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 family history of Lynch syndrome undergoes targeted mRNA sequence analysis of the 10 genes associated with hereditary colon cancer disorders.
2. A clinician orders CPT 0130U to improve variant classification for a patient with PTEN hamartoma syndrome.
3. A patient with Cowden syndrome undergoes targeted mRNA sequence analysis to guide medical management and determine the need for earlier colonoscopies.
4. A family with a history of familial adenomatosis polyposis undergoes analysis of the 10 genes to assess the risk of developing cancerous tumors.
5. A patient with an unknown hereditary colon cancer disorder undergoes targeted mRNA sequence analysis to identify specific genetic variants and guide medical interventions.