How To Use CPT Code 0161U

CPT 0161U describes a specific laboratory test called CustomNext® + RNA: PMS2, which is performed by Ambry Genetics®. This test involves mRNA sequence analysis of the PMS2 gene, and it is used in conjunction with the primary procedure code 81317. In this article, we will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0161U.

1. What is CPT Code 0161U?

CPT 0161U is a proprietary laboratory analysis (PLA) code that applies to a specific lab test performed by Ambry Genetics®. It is used to report the CustomNext® + RNA: PMS2 test, which involves mRNA sequence analysis of the PMS2 gene. This test is performed in conjunction with the primary procedure code 81317, which covers the full sequence analysis.

2. Official Description

The official description of CPT code 0161U is: ‘PMS2 (PMS1 homolog 2, mismatch repair system component) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure).’ This code should be reported when the CustomNext® + RNA: PMS2 test is performed in conjunction with the primary procedure code 81317.

3. Procedure

1. After performing the full sequence analysis of the PMS2 gene, the lab analyst proceeds with mRNA sequencing.
2. MRNA sequencing is performed to quantify gene expression, identify novel RNA transcripts and gene fusions, and provide more accurate quantification of overlapping transcripts and allele-specific expression.
3. The analyst uses a specialized automated instrument to determine the order of nucleotides in the DNA and reports the sequence as a string of letters.
4. This sequence is then compared to a reference library of normal genomes and variant gene sequences associated with certain conditions.

4. Qualifying circumstances

CPT 0161U is used for patients who require mRNA sequence analysis of the PMS2 gene. This test is typically ordered to diagnose and plan treatment for patients with hereditary non-polyposis colorectal cancer (Lynch syndrome), a type of inherited colon cancer not associated with polyposis.

5. When to use CPT code 0161U

CPT code 0161U should be used when the CustomNext® + RNA: PMS2 test is performed in conjunction with the primary procedure code 81317. It is important to note that this code should only be reported for the specific proprietary test described and should not be reported with any other CPT code.

6. Documentation requirements

To support a claim for CPT code 0161U, the following documentation is required:

• Documentation of the full sequence analysis of the PMS2 gene
• Documentation of the mRNA sequencing performed
• Date of service and the specific test performed
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0161U, it is important to ensure that the test is performed by Ambry Genetics® and that it is reported in conjunction with the primary procedure code 81317. This code should not be reported with any other CPT code. It is also recommended to check with the appropriate payer regarding payment for the collection of the specimen.

8. Historical information

CPT code 0161U was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A patient with a family history of Lynch syndrome undergoes the CustomNext® + RNA: PMS2 test to determine their risk of hereditary non-polyposis colorectal cancer.
2. A clinician orders the CustomNext® + RNA: PMS2 test for a patient with suspected Lynch syndrome to guide treatment decisions.
3. A patient with a known PMS2 gene mutation undergoes the CustomNext® + RNA: PMS2 test to assess gene expression and allele-specific expression.
4. A patient with a previous diagnosis of Lynch syndrome undergoes the CustomNext® + RNA: PMS2 test to monitor their response to treatment.
5. A patient with a family history of hereditary non-polyposis colorectal cancer undergoes the CustomNext® + RNA: PMS2 test to determine if they carry the PMS2 gene mutation.
6. A clinician orders the CustomNext® + RNA: PMS2 test for a patient with atypical clinical features suggestive of Lynch syndrome.
7. A patient with a previous diagnosis of Lynch syndrome undergoes the CustomNext® + RNA: PMS2 test to assess their risk of developing other types of cancer associated with this condition.
8. A patient with a family history of Lynch syndrome undergoes the CustomNext® + RNA: PMS2 test to determine if they inherited the PMS2 gene mutation.
9. A clinician orders the CustomNext® + RNA: PMS2 test for a patient with a suspected PMS2 gene mutation based on clinical symptoms and family history.
10. A patient with a previous diagnosis of hereditary non-polyposis colorectal cancer undergoes the CustomNext® + RNA: PMS2 test to assess their risk of recurrence.