How To Use CPT Code 0167U

CPT 0167U describes a specific laboratory test known as the AdexusDx® hCG Test from NOWDiagnostics. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0167U.

1. What is CPT Code 0167U?

CPT 0167U is a unique code that represents the AdexusDx® hCG Test from NOWDiagnostics. This test is a rapid chromatographic immunoassay with direct optical observation, designed to detect human chorionic gonadotropin (hCG) in a single drop of blood. It is primarily used to diagnose early pregnancy.

2. Official Description

The official description of CPT code 0167U is: ‘Gonadotropin, chorionic (hCG), immunoassay with direct optical observation, blood.’

3. Procedure

1. The lab analyst collects a drop of blood from the patient, typically through a fingerstick.
2. The blood sample is applied to the test device, specifically the application zone.
3. Within 10 minutes, the sample flows through membranes containing color-labeled anti-hCG antibodies.
4. If hCG is present in the sample, the antibodies react and become immobilized at the test band position, indicating a positive result.
5. If no hCG is present, the antibodies remain at the control band position, indicating a negative result.
6. The test result is determined through direct optical observation.

4. Qualifying circumstances

The AdexusDx® hCG Test is primarily used to determine pregnancy at an earlier stage than most urine test methods. It detects the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta. It is important to note that elevated hCG levels can also be found in certain types of cancer and after a miscarriage.

5. When to use CPT code 0167U

CPT code 0167U should be used specifically for the AdexusDx® hCG Test from NOWDiagnostics. It is important not to report other CPT codes for hCG, such as 84702, 84703, or 84704, in place of or in addition to 0167U for this specific test.

6. Documentation requirements

To support a claim for CPT code 0167U, the following documentation is required:

• Indication of the need for the AdexusDx® hCG Test
• Date of service
• Results of the test, including whether hCG was detected or not
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0167U, ensure that the AdexusDx® hCG Test from NOWDiagnostics is being performed. It is important to report one unit of this code for a single specimen analyzed on a single date of service. Some payers may also separately reimburse for the collection of the specimen, so it is advisable to check with the appropriate payer.

8. Historical information

CPT code 0167U was added to the Current Procedural Terminology system on April 1, 2020. As a Proprietary Laboratory Analyses (PLA) code, it is specific to the AdexusDx® hCG Test from NOWDiagnostics and takes precedence over other codes for laboratory/pathology.

9. Examples

1. A lab analyst performs the AdexusDx® hCG Test on a blood sample obtained from a patient to determine pregnancy.
2. A healthcare provider orders the AdexusDx® hCG Test for a patient who has experienced a miscarriage to confirm the absence of hCG.
3. A pregnant patient undergoes the AdexusDx® hCG Test to monitor the progression of hCG levels during early pregnancy.
4. A physician uses the AdexusDx® hCG Test to rule out pregnancy in a patient with suspected ectopic pregnancy.
5. A healthcare facility offers the AdexusDx® hCG Test as part of their routine pregnancy screening program.
6. A lab technician performs the AdexusDx® hCG Test on a blood sample to determine if hCG levels are elevated, potentially indicating the presence of certain types of cancer.
7. A patient undergoes the AdexusDx® hCG Test to confirm pregnancy before starting a new medication that may be contraindicated during pregnancy.
8. A healthcare provider orders the AdexusDx® hCG Test for a patient with irregular menstrual cycles to help determine the timing of ovulation.
9. A pregnant patient undergoes the AdexusDx® hCG Test to monitor the decline of hCG levels after a miscarriage.
10. A lab analyst performs the AdexusDx® hCG Test on a blood sample obtained from a patient to confirm the success of an in vitro fertilization (IVF) procedure.