How To Use CPT Code 0228U

CPT 0228U describes a specific laboratory test called PanGIA Prostate, which is performed by the Genetics Institute of America from Entopsis LLC. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0228U.

1. What is CPT Code 0228U?

CPT 0228U is a Proprietary Laboratory Analyses (PLA) code that applies to a unique lab test performed by a specific manufacturer or lab. It is used to report the PanGIA Prostate test provided by the Genetics Institute of America from Entopsis LLC. This test involves the capture and algorithmic analysis of bio-molecules in a patient’s first morning voided urine specimen to determine the likelihood of prostate cancer.

2. Official Description

The official description of CPT code 0228U is: ‘Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer.’

3. Procedure

1. The lab analyst processes a first-morning-voided urine specimen using a proprietary nanoscale capture of bio-molecules.
2. The captured bio-molecules are analyzed by a machine-learning algorithm to classify the urine-specimen signature as consistent with men who were confirmed negative or positive for prostate cancer after biopsy.
3. This test does not focus on a specific condition, but it can be ordered by clinicians for patients suspected of having prostate cancer to inform the decision for a prostate biopsy.

4. Qualifying circumstances

CPT code 0228U is used for patients who are suspected of having prostate cancer and require further evaluation. The test is performed on a first morning voided urine specimen, and the results are reported as the likelihood of prostate cancer. It is important to note that this code is specific to the PanGIA Prostate test provided by the Genetics Institute of America from Entopsis LLC.

5. When to use CPT code 0228U

CPT code 0228U should be used when ordering the PanGIA Prostate test for patients suspected of having prostate cancer. It should not be used for any other tests or conditions. It is crucial to ensure that the test is performed by the Genetics Institute of America from Entopsis LLC and that the patient’s urine specimen is analyzed using the specified algorithm.

6. Documentation requirements

To support a claim for CPT code 0228U, the documentation should include:

• Indication for ordering the PanGIA Prostate test
• Date of service
• Results of the test, including the likelihood of prostate cancer
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0228U, ensure that the test is performed by the Genetics Institute of America from Entopsis LLC and that the results are reported as the likelihood of prostate cancer. This code should not be reported with any other CPT codes unless specified by the payer. It is also important to check with the appropriate payer regarding any separate payment for specimen collection.

8. Historical information

CPT code 0228U was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders the PanGIA Prostate test for a patient with elevated PSA levels to determine the likelihood of prostate cancer.
2. A urologist requests the PanGIA Prostate test for a patient with suspicious findings on a digital rectal exam.
3. A primary care physician orders the PanGIA Prostate test for a patient with a family history of prostate cancer.
4. An oncologist utilizes the PanGIA Prostate test to monitor the effectiveness of treatment in a patient with a known diagnosis of prostate cancer.
5. A patient undergoes the PanGIA Prostate test as part of a routine screening for prostate cancer.
6. A urologist orders the PanGIA Prostate test for a patient with persistent urinary symptoms and concerns about prostate cancer.
7. A patient with a previous negative prostate biopsy undergoes the PanGIA Prostate test to assess the need for a repeat biopsy.
8. A clinician utilizes the PanGIA Prostate test to guide the decision for a prostate biopsy in a patient with an inconclusive imaging study.
9. An oncologist orders the PanGIA Prostate test to assess the risk of prostate cancer recurrence in a patient who has completed treatment.
10. A primary care physician utilizes the PanGIA Prostate test to aid in the early detection of prostate cancer in a patient with no symptoms but with risk factors.