How To Use CPT Code 0152U

CPT 0152U describes a proprietary laboratory analysis (PLA) test that is used to detect and report potentially pathogenic organisms in plasma using next-generation sequencing (NGS). This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0152U.

1. What is CPT Code 0152U?

CPT 0152U is a unique code that represents a specific laboratory test called the Karius® test from Karius, Inc. This test utilizes next-generation sequencing (NGS) to analyze a plasma specimen and identify potentially pathogenic organisms. It is a proprietary test, meaning it is specific to the Karius® test and cannot be used for other similar tests.

2. Official Description

The official description of CPT code 0152U is: ‘Infectious disease (bacteria, fungi, parasites, and DNA viruses), microbial cell-free DNA, plasma, untargeted next-generation sequencing, report for significant positive pathogens.’

3. Procedure

1. The laboratory analyst isolates cell-free DNA from a plasma specimen and removes interfering human DNA.
2. Next-generation sequencing (NGS) is performed on the specimen to identify any pathogenic organisms present.
3. The DNA signatures of over 1,300 organisms, including bacteria, DNA viruses, fungi, molds, and parasites, are compared to the specimen’s DNA to determine the presence of significant positive pathogens.
4. A report is generated detailing the pathogens identified, their concentration based on the number of cell-free nucleic acid molecules per microliter of plasma, and any other relevant information.

4. Qualifying circumstances

CPT 0152U is typically ordered for patients with suspected infectious diseases caused by bacteria, fungi, parasites, or DNA viruses. It is particularly useful for patients with conditions such as complicated pneumonia, immunodeficiencies, and endocarditis, where the causative organism may be difficult to diagnose or identify. The test is performed on plasma specimens and requires the use of next-generation sequencing (NGS) technology.

5. When to use CPT code 0152U

CPT code 0152U should be used when the Karius® test from Karius, Inc. is performed to detect and report potentially pathogenic organisms in plasma using untargeted next-generation sequencing (NGS). It is important to note that this code is specific to the Karius® test and should not be used for other similar tests.

6. Documentation requirements

To support a claim for CPT code 0152U, the following documentation is typically required:

• Order for the Karius® test
• Date of service
• Plasma specimen details
• Results of the test, including the pathogens identified and their concentrations
• Any additional relevant information

7. Billing guidelines

When billing for CPT code 0152U, it is important to ensure that the test is performed by Karius, Inc. using their proprietary Karius® test. This code should not be reported for any other similar tests. Additionally, it is advisable to check with the appropriate payer regarding any specific billing requirements or coverage policies for this test.

8. Historical information

CPT code 0152U was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with complicated pneumonia undergoes the Karius® test to identify the causative pathogen.
2. A patient with an immunodeficiency is tested using the Karius® test to determine the presence of any potentially pathogenic organisms.
3. A patient with suspected endocarditis undergoes the Karius® test to identify the responsible pathogen.
4. A critically ill patient with an unknown infection undergoes the Karius® test to aid in diagnosis and treatment.
5. A patient with a suspected viral infection undergoes the Karius® test to identify the specific DNA virus causing the illness.
6. A patient with a suspected fungal infection undergoes the Karius® test to determine the presence of any fungal pathogens.
7. A patient with a suspected parasitic infection undergoes the Karius® test to identify the responsible parasite.
8. A patient with an undiagnosed infectious disease undergoes the Karius® test to aid in the identification of the causative organism.
9. A patient with a suspected bacterial infection undergoes the Karius® test to determine the presence of any bacterial pathogens.
10. A patient with a suspected viral respiratory infection undergoes the Karius® test to identify the specific DNA virus causing the illness.