How To Use CPT Code 0137U

CPT 0137U describes a proprietary laboratory analysis (PLA) code for the RNAinsight™ for PALB2 test from Ambry Genetics. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0137U.

1. What is CPT Code 0137U?

CPT 0137U is a unique PLA code that represents the RNAinsight™ for PALB2 test offered by Ambry Genetics. This test involves mRNA sequence analysis to improve variant classification of the PALB2 gene, which is associated with breast, pancreatic, and other cancers. It is an add-on code that should be reported in addition to the primary procedure code for full gene sequencing of the PALB2 gene.

2. Official Description

The official description of CPT code 0137U is: ‘PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) mRNA sequence analysis (List separately in addition to code for primary procedure).’ This code is used to report the RNAinsight™ for PALB2 test from Ambry Genetics, which helps in better classification of splicing variants of the PALB2 gene.

3. Procedure

1. The lab analyst performs mRNA sequence analysis of the PALB2 gene using high-throughput, qualitative, and quantitative sequence analysis technology.
2. This analysis allows for better classification of splicing variants and helps in identifying at-risk individuals for breast, pancreatic, prostate, ovarian, and other cancers.
3. The test is ordered by clinicians as an adjunct to DNA genetic testing to improve variant classification and identify individuals who may require earlier or more frequent imaging, testing, or prophylactic surgical measures.
4. The mRNA sequence analysis is performed on a single specimen analyzed on a single date of service.
5. Results of the analysis guide medical management, tailor treatments, and determine the need for additional imaging or testing for patients with cancers associated with the PALB2 gene.

4. Qualifying circumstances

CPT code 0137U is appropriate for patients who require better classification of splicing variants of the PALB2 gene. This test is typically ordered for individuals with early onset breast cancer, multiple primary breast cancers, close relatives with the same, or male relatives with breast cancer. It is used in conjunction with full gene sequencing of the PALB2 gene and helps in identifying individuals at risk for various cancers associated with the PALB2 gene.

5. When to use CPT code 0137U

CPT code 0137U should be used when ordering the RNAinsight™ for PALB2 test from Ambry Genetics as an add-on to the primary procedure code for full gene sequencing of the PALB2 gene. It should only be reported for the specific proprietary test and not with any other CPT code. This code is used to improve variant classification and guide medical management for patients with PALB2 gene-related cancers.

6. Documentation requirements

To support a claim for CPT code 0137U, the following documentation is required:

• Order for the RNAinsight™ for PALB2 test
• Documentation of the primary procedure code for full gene sequencing of the PALB2 gene
• Date of service for the mRNA sequence analysis
• Results of the analysis, including variant classification and implications for clinical management
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 0137U, ensure that the test is performed by Ambry Genetics and is reported as an add-on to the primary procedure code for full gene sequencing of the PALB2 gene. This code should not be reported with any other CPT code. Some payers may also separately reimburse for specimen collection, so it is important to check with the appropriate payer for their specific billing requirements.

8. Historical information

CPT code 0137U was added to the Current Procedural Terminology system on October 1, 2019. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with early onset breast cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to improve variant classification and guide medical management.
2. A patient with multiple primary breast cancers and a family history of breast cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to identify at-risk relatives and guide medical management.
3. A male patient with breast cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to assess the risk for other PALB2 gene-related cancers.
4. A patient with pancreatic cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to determine the need for earlier or more frequent imaging and testing.
5. A patient with ovarian cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to guide medical management and tailor treatments.
6. A patient with prostate cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to assess the risk for other PALB2 gene-related cancers.
7. A patient with a family history of breast cancer and close relatives with the same undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to identify at-risk individuals and guide medical management.
8. A patient with early onset breast cancer and a male relative with breast cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to assess the risk for other PALB2 gene-related cancers in the family.
9. A patient with a family history of pancreatic cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to determine the need for earlier or more frequent imaging and testing.
10. A patient with a family history of ovarian cancer undergoes full gene sequencing of the PALB2 gene, and the RNAinsight™ for PALB2 test is performed to guide medical management and tailor treatments.