How To Use CPT Code 0136U

CPT 0136U describes a proprietary laboratory analysis (PLA) code used for the RNAinsight™ for ATM test from Ambry Genetics. This targeted mRNA sequence analysis is designed to improve the classification of variants in the ATM (ataxia telangiectasia mutated) gene, which is associated with ataxia telangiectasia, a rare hereditary disorder affecting the nervous and immune systems. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0136U.

1. What is CPT Code 0136U?

CPT 0136U is a proprietary laboratory analysis (PLA) code that applies to the RNAinsight™ for ATM test from Ambry Genetics. This test is a targeted mRNA sequence analysis that aims to improve the classification of variants in the ATM gene. The ATM gene is associated with ataxia telangiectasia, a rare hereditary disorder characterized by lack of voluntary coordination, muscle movement difficulties, dilated veins, weakened immune system, and increased risk of leukemia and lymphoma.

2. Official Description

The official description of CPT code 0136U is a targeted mRNA sequence analysis of the ATM gene, performed as an add-on to a level 9 molecular pathology procedure for full gene sequencing of ATM. This analysis uses a high-throughput, qualitative, and quantitative sequence analysis technology to better classify splicing variants and improve the accuracy of genetic testing for ataxia telangiectasia.

3. Procedure

1. The lab analyst carries out targeted mRNA sequence analysis of the ATM gene using a high-throughput, qualitative, and quantitative sequence analysis technology.
2. This analysis focuses on specific gene regions to identify variants and better classify splicing variants.
3. The analysis is performed as an add-on to a level 9 molecular pathology procedure for full gene sequencing of the ATM gene.
4. The targeted mRNA sequence analysis allows for improved classification of variants and enhances the accuracy of genetic testing for ataxia telangiectasia.

4. Qualifying circumstances

CPT 0136U is used for patients who require genetic testing for ataxia telangiectasia. This test is typically ordered as an adjunct to DNA genetic testing to improve the classification of variants that may impact clinical outcomes. It is particularly useful for identifying at-risk individuals, such as those with early onset breast cancer or first-degree relatives with an ATM mutation or early onset breast cancer. The test helps guide medical management, tailor treatments, and determine the need for earlier or more frequent imaging, testing, or prophylactic surgical measures.

5. When to use CPT code 0136U

CPT code 0136U should be used when performing the RNAinsight™ for ATM test from Ambry Genetics as an add-on to a level 9 molecular pathology procedure for full gene sequencing of the ATM gene. This code should only be reported for the specific proprietary test and should not be reported with any other CPT code. It is important to ensure that the test is performed on human specimens requested by the clinical lab offering the test.

6. Documentation requirements

To support a claim for CPT code 0136U, the following documentation is required:

• Indication for the RNAinsight™ for ATM test
• Documentation of the primary procedure, level 9 molecular pathology procedure for full gene sequencing of the ATM gene
• Date of service for the test
• Results of the targeted mRNA sequence analysis
• Interpretation of the analysis and its impact on clinical management
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 0136U, ensure that the test is performed as an add-on to a level 9 molecular pathology procedure for full gene sequencing of the ATM gene. Report one unit of this code for a single specimen analyzed on a single date of service. It is important to note that this is a proprietary laboratory analysis (PLA) code and should not be reported with any other CPT code. Some payers may also separately reimburse for specimen collection, so it is advisable to check with the appropriate payer for their specific guidelines.

8. Historical information

CPT code 0136U was added to the Current Procedural Terminology system on October 1, 2019. As a relatively new code, there have been no updates or changes to the code since its addition.

9. Examples

1. A patient with early onset breast cancer undergoes the RNAinsight™ for ATM test to better classify variants in the ATM gene and guide medical management.
2. A patient with a family history of ataxia telangiectasia and multiple close relatives with breast, pancreatic, or prostate cancer undergoes the RNAinsight™ for ATM test to identify at-risk individuals and determine the need for earlier or more frequent imaging and testing.
3. A patient with ataxia telangiectasia undergoes the RNAinsight™ for ATM test to assess the impact of specific variants on their clinical outcomes and tailor treatments accordingly.
4. A patient with ataxia telangiectasia and chronic lung infections undergoes the RNAinsight™ for ATM test to better understand the genetic factors contributing to their condition and guide medical management.
5. A patient with ataxia telangiectasia and an increased risk of leukemia and lymphoma undergoes the RNAinsight™ for ATM test to assess the impact of specific variants on their cancer risk and determine appropriate surveillance and treatment measures.
6. A patient with early onset breast cancer and a family history of ataxia telangiectasia undergoes the RNAinsight™ for ATM test to identify potential genetic factors contributing to their cancer and guide medical management.
7. A patient with ataxia telangiectasia and a family history of breast cancer undergoes the RNAinsight™ for ATM test to assess the impact of specific variants on their cancer risk and determine appropriate surveillance measures.
8. A patient with ataxia telangiectasia and a family history of pancreatic cancer undergoes the RNAinsight™ for ATM test to identify potential genetic factors contributing to their cancer risk and guide medical management.
9. A patient with ataxia telangiectasia and a family history of prostate cancer undergoes the RNAinsight™ for ATM test to assess the impact of specific variants on their cancer risk and determine appropriate surveillance measures.
10. A patient with ataxia telangiectasia and a family history of breast, pancreatic, and prostate cancer undergoes the RNAinsight™ for ATM test to assess the impact of specific variants on their cancer risk and guide medical management.