How To Use CPT Code 0164U

CPT 0164U describes a proprietary laboratory analysis (PLA) code for the ibs-smart™ test from Gemelli Biotech. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples related to CPT code 0164U.

1. What is CPT Code 0164U?

CPT 0164U is a unique PLA code that represents the ibs-smart™ test offered by Gemelli Biotech. This test is designed to diagnose irritable bowel syndrome (IBS) by measuring the levels of anti-CdtB and anti-vinculin antibodies in a patient’s plasma. The test utilizes an algorithm to determine if the results are elevated or not, providing valuable diagnostic information for clinicians.

2. Official Description

The official description of CPT code 0164U is: ‘Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for anti-CdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results.’

3. Procedure

1. The lab analyst performs an immunoassay to measure the levels of anti-CdtB and anti-vinculin antibodies in a plasma specimen.
2. The immunoassay uses an antigen substrate to react with the specific antibodies in the specimen, creating a quantifiable signal.
3. The ibs-smart™ test utilizes an algorithm to analyze the results as either elevated or not elevated for each antibody.
4. The test helps diagnose IBS with a diarrheal component or indicates the need for further testing to distinguish between IBS and inflammatory bowel disease (IBD).

4. Qualifying circumstances

CPT code 0164U is applicable for patients with intestinal symptoms such as bloating, cramping, and diarrhea, who are being evaluated for a possible diagnosis of IBS. The test is particularly useful for patients with a history of gastroenteritis related to past food poisoning. It is important to note that this code should only be used for the ibs-smart™ test from Gemelli Biotech and not for any other anti-CdtB and anti-vinculin antibody tests.

5. When to use CPT code 0164U

CPT code 0164U should be used when a clinician orders the ibs-smart™ test from Gemelli Biotech to help diagnose IBS with a diarrheal component or to indicate the need for further testing to distinguish between IBS and IBD. It is important to ensure that the test is performed on a plasma specimen and that the results are analyzed using the specific algorithm provided by Gemelli Biotech.

6. Documentation requirements

To support a claim for CPT code 0164U, the following documentation is required:

• Indication of the patient’s symptoms and the need for IBS diagnosis
• Confirmation that the ibs-smart™ test from Gemelli Biotech was ordered
• Date of the test and the specific results obtained
• Documentation of the algorithm used to analyze the results as elevated or not elevated
• Signature of the clinician who ordered the test

7. Billing guidelines

When billing for CPT code 0164U, it is important to ensure that the test is performed by Gemelli Biotech for the ibs-smart™ test. Only report one unit of this code for a single specimen analyzed on a single date of service. It is also advisable to check with the appropriate payer regarding separate payment for specimen collection. Do not report any other CPT codes for anti-CdtB and anti-vinculin antibodies in place of or in addition to CPT code 0164U.

8. Historical information

CPT code 0164U was added to the Current Procedural Terminology system on April 1, 2020. As a relatively new code, there have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders the ibs-smart™ test from Gemelli Biotech for a patient presenting with chronic diarrhea and a history of gastroenteritis. The test results indicate elevated levels of anti-CdtB and anti-vinculin antibodies, confirming a diagnosis of IBS with a diarrheal component.
2. A patient with persistent abdominal pain and bloating undergoes the ibs-smart™ test from Gemelli Biotech. The test results show no elevation in anti-CdtB and anti-vinculin antibodies, indicating the need for further testing to differentiate between IBS and IBD.
3. A clinician suspects IBS in a patient with recurring gastrointestinal symptoms. The ibs-smart™ test from Gemelli Biotech is ordered, and the results reveal elevated levels of anti-CdtB and anti-vinculin antibodies, confirming the diagnosis of IBS with a diarrheal component.
4. A patient with a history of gastroenteritis and ongoing gastrointestinal symptoms undergoes the ibs-smart™ test from Gemelli Biotech. The test results show no elevation in anti-CdtB and anti-vinculin antibodies, indicating the need for further testing to differentiate between IBS and IBD.
5. A clinician orders the ibs-smart™ test from Gemelli Biotech for a patient experiencing chronic diarrhea and abdominal pain. The test results indicate elevated levels of anti-CdtB and anti-vinculin antibodies, confirming a diagnosis of IBS with a diarrheal component.
6. A patient with persistent gastrointestinal symptoms undergoes the ibs-smart™ test from Gemelli Biotech. The test results show no elevation in anti-CdtB and anti-vinculin antibodies, indicating the need for further testing to differentiate between IBS and IBD.
7. A clinician suspects IBS in a patient with recurring abdominal discomfort. The ibs-smart™ test from Gemelli Biotech is ordered, and the results reveal elevated levels of anti-CdtB and anti-vinculin antibodies, confirming the diagnosis of IBS with a diarrheal component.
8. A patient with a history of gastroenteritis and ongoing gastrointestinal symptoms undergoes the ibs-smart™ test from Gemelli Biotech. The test results show no elevation in anti-CdtB and anti-vinculin antibodies, indicating the need for further testing to differentiate between IBS and IBD.
9. A clinician orders the ibs-smart™ test from Gemelli Biotech for a patient experiencing chronic diarrhea and abdominal pain. The test results indicate elevated levels of anti-CdtB and anti-vinculin antibodies, confirming a diagnosis of IBS with a diarrheal component.
10. A patient with persistent gastrointestinal symptoms undergoes the ibs-smart™ test from Gemelli Biotech. The test results show no elevation in anti-CdtB and anti-vinculin antibodies, indicating the need for further testing to differentiate between IBS and IBD.