How To Use CPT Code 0240U

CPT 0240U describes a proprietary laboratory analysis (PLA) code for a specific viral respiratory tract infection test. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0240U?

CPT 0240U can be used to report a specific laboratory test for infectious disease. This test detects the presence or absence of three targets: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and influenza B. It is performed on an upper respiratory specimen and provides valuable information for diagnosing viral respiratory infections.

2. Official Description

The official description of CPT code 0240U is: ‘Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.’

3. Procedure

1. The laboratory analyst prepares the specimen, typically obtained from the nasopharynx, nasal cavity, or nasal wash.
2. The specimen is transferred to the sample chamber of the specific test cartridge, such as the Xpert® Xpress SARS–CoV–2/Flu/RSV cartridge from Cepheid.
3. The cartridge is loaded onto the platform for automated sample processing and real-time reverse transcription polymerase chain reaction (RT-PCR) to detect the viral targets.
4. The results indicate whether each pathogen (SARS-CoV-2, influenza A, and influenza B) is detected or not detected.
5. The entire process takes approximately 30-40 minutes, providing rapid and accurate results.

4. Qualifying circumstances

CPT 0240U is used for patients suspected of having a viral respiratory tract infection. It is particularly useful for differentiating between COVID-19 (caused by SARS-CoV-2) and influenza. The test is performed on human specimens and is requested by the clinical lab offering the specific proprietary test.

5. When to use CPT code 0240U

CPT code 0240U should be used when the specific proprietary test, such as the Xpert® Xpress SARS–CoV–2/Flu/RSV test, is performed to detect the presence or absence of SARS-CoV-2, influenza A, and influenza B in an upper respiratory specimen. It should not be reported for any other laboratory test or for specimens other than those specified.

6. Documentation requirements

To support a claim for CPT 0240U, the documentation should include:

• Patient information and reason for testing
• Details of the specific proprietary test used
• Date of service and specimen collection
• Results indicating whether each pathogen was detected or not detected
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT 0240U, ensure that the test performed matches the specific proprietary test associated with the code. Report one unit of this code for a single specimen analyzed on a single date of service. Some payers may also separately reimburse for specimen collection, so it is important to check with the appropriate payer for their specific guidelines.

8. Historical information

CPT 0240U, a proprietary laboratory analysis code, was added to the CPT code set on October 6, 2020. As of now, there have been no updates or changes to this code.

9. Examples

1. A patient presents with respiratory symptoms, and the Xpert® Xpress SARS–CoV–2/Flu/RSV test is performed to determine whether they have COVID-19 or influenza.
2. A healthcare provider suspects a viral respiratory tract infection in a patient and orders the specific proprietary test to differentiate between SARS-CoV-2, influenza A, and influenza B.
3. A patient with flu-like symptoms undergoes the Xpert® Xpress SARS–CoV–2/Flu/RSV test to confirm the presence or absence of SARS-CoV-2 and influenza viruses.
4. A clinical lab performs the specific proprietary test on a specimen collected from a patient with respiratory symptoms to identify the viral pathogens causing the infection.
5. A physician orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test for a patient with suspected viral respiratory infection to guide appropriate treatment and management.
6. A patient with respiratory symptoms undergoes the specific proprietary test to determine whether they have COVID-19, influenza A, or influenza B.
7. A healthcare provider requests the Xpert® Xpress SARS–CoV–2/Flu/RSV test for a patient with suspected viral respiratory tract infection to aid in diagnosis and treatment decisions.
8. A clinical lab analyzes a specimen from a patient with respiratory symptoms using the specific proprietary test to identify the presence or absence of SARS-CoV-2, influenza A, and influenza B.
9. A patient with flu-like symptoms undergoes the Xpert® Xpress SARS–CoV–2/Flu/RSV test to determine the viral pathogens responsible for the infection.
10. A physician orders the specific proprietary test for a patient with suspected viral respiratory infection to accurately diagnose the causative pathogens.