How To Use CPT Code 0138U

CPT 0138U describes a specific laboratory analysis test for the mRNA sequence analysis of the BRCA1 and BRCA2 genes, which are associated with hereditary breast and ovarian cancer. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0138U.

1. What is CPT Code 0138U?

CPT 0138U can be used to report the RNAinsight™ for BRCA1/2 test from Ambry Genetics. This test involves mRNA sequence analysis of the BRCA1 and BRCA2 genes to improve variant classification of these genes, which are implicated in various hereditary breast cancer–related disorders. It is important to note that CPT 0138U should only be reported in conjunction with the primary procedure code 81162 for BRCA1 and BRCA2 full gene analysis and duplication/deletion analysis.

2. Official Description

The official description of CPT code 0138U is: ‘BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) mRNA sequence analysis (List separately in addition to code for primary procedure)’. This code is specific to the RNAinsight™ for BRCA1/2 test from Ambry Genetics and should be reported separately in addition to the primary procedure code.

3. Procedure

1. The laboratory analyst performs mRNA sequence analysis of the BRCA1 and BRCA2 genes using a high throughput, qualitative, and quantitative sequence analysis technology.
2. This analysis allows for better classification of splicing variants and improves the accuracy of variant classification.
3. The mRNA sequence analysis is typically performed using technologies such as CloneSeq™.
4. The test focuses on the BRCA1 and BRCA2 genes, which are tumor suppressor genes associated with hereditary breast cancer–related disorders.
5. The results of the mRNA sequence analysis provide valuable information for clinicians to manage hereditary cancer–related disorders, such as hereditary breast, ovarian, and endometrial cancers.

4. Qualifying circumstances

CPT 0138U is used for patients who require mRNA sequence analysis of the BRCA1 and BRCA2 genes to improve variant classification. These patients typically have a family history of hereditary breast cancer–related disorders or other risk factors that warrant genetic testing. The test is ordered by clinicians to better classify variants that may impact clinical outcomes and guide medical management for at-risk individuals.

5. When to use CPT code 0138U

CPT code 0138U should be used when reporting the RNAinsight™ for BRCA1/2 test from Ambry Genetics. It is important to note that this code should only be reported in addition to the primary procedure code 81162 for BRCA1 and BRCA2 full gene analysis and duplication/deletion analysis. The test is specifically designed to improve variant classification of the BRCA1 and BRCA2 genes and is used to guide medical management for hereditary breast cancer–related disorders.

6. Documentation requirements

To support a claim for CPT code 0138U, the documentation should include:

• Indication for the test, such as a family history of hereditary breast cancer–related disorders or other risk factors
• Details of the mRNA sequence analysis performed, including the technology used
• Date of service
• Results of the analysis and any relevant findings
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT code 0138U, ensure that the test is performed by the specific laboratory mentioned in the official description. This code should be reported in addition to the primary procedure code 81162. It is important to note that some payers may separately reimburse for specimen collection, so it is advisable to check with the appropriate payer for their specific billing requirements.

8. Historical information

CPT code 0138U 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 a family history of hereditary breast cancer undergoes the RNAinsight™ for BRCA1/2 test to improve variant classification and guide medical management.
2. A clinician orders the RNAinsight™ for BRCA1/2 test for a patient with risk factors for hereditary breast cancer–related disorders to determine the need for earlier or more frequent imaging and testing.
3. A patient with a known BRCA1 or BRCA2 variant undergoes the RNAinsight™ for BRCA1/2 test to better classify the variant and tailor treatments for hereditary cancer–related disorders.
4. A patient with a history of endometrial cancer undergoes the RNAinsight™ for BRCA1/2 test to assess the risk of hereditary breast and ovarian cancer.
5. A patient with a family history of hereditary breast cancer undergoes the RNAinsight™ for BRCA1/2 test to identify at-risk individuals and guide prophylactic surgical measures.
6. A clinician orders the RNAinsight™ for BRCA1/2 test for a patient with a known BRCA1 or BRCA2 variant to determine the need for more frequent monitoring and medical management.
7. A patient with a family history of hereditary breast cancer undergoes the RNAinsight™ for BRCA1/2 test to assess the risk of developing breast and ovarian cancer.
8. A clinician orders the RNAinsight™ for BRCA1/2 test for a patient with a variant of uncertain significance in the BRCA1 or BRCA2 gene to improve variant classification and guide medical management.
9. A patient with a family history of hereditary breast cancer undergoes the RNAinsight™ for BRCA1/2 test to identify individuals who may benefit from genetic counseling and testing.
10. A clinician orders the RNAinsight™ for BRCA1/2 test for a patient with a known BRCA1 or BRCA2 variant to determine the need for targeted therapies and personalized treatment plans.