How To Use CPT Code 0247U

CPT 0247U describes a proprietary laboratory analysis (PLA) code for the PreTRM® test from Sera Prognostics, Inc. This test utilizes maternal serum and quantitative measurement by LC-MS/MS to evaluate the levels of insulin-like growth factor-binding protein 4 (IBP4) and sex hormone-binding globulin (SHBG). The test also incorporates clinical data to report a predictive-risk stratification score for spontaneous preterm birth. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0247U.

1. What is CPT Code 0247U?

CPT 0247U is a proprietary laboratory analysis (PLA) code specifically designed for the PreTRM® test from Sera Prognostics, Inc. This test utilizes maternal serum and quantitative measurement by LC-MS/MS to evaluate the levels of insulin-like growth factor-binding protein 4 (IBP4) and sex hormone-binding globulin (SHBG). By incorporating clinical data, the test provides a predictive-risk stratification score for spontaneous preterm birth. It is important to note that CPT code 0247U should only be used for the PreTRM® test from Sera Prognostics, Inc., and not for any other similar tests.

2. Official Description

The official description of CPT code 0247U is: ‘Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone-binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal serum, combined with clinical data, reported as predictive-risk stratification for spontaneous preterm birth.’

3. Procedure

1. The PreTRM® test is performed using maternal serum collected during gestation weeks 19 or 20.
2. The lab analyst utilizes liquid chromatography-tandem mass spectrometry (LC-MS/MS) to quantify the levels of IBP4 and SHBG in the patient specimen.
3. An algorithmic analysis is conducted using the clinical data and measured IBP4 and SHBG levels to generate a risk stratification score for spontaneous preterm birth.
4. The test result includes the risk stratification score, which helps clinicians identify women at risk of preterm birth and allows for appropriate preventive interventions.

4. Qualifying circumstances

CPT code 0247U is applicable for women who are pregnant with a single child during the 19th or 20th week of pregnancy. The test is specifically ordered to help predict the likelihood of spontaneous preterm birth, which is a leading cause of infant mortality and morbidity. It is important to note that this code should only be used for the PreTRM® test from Sera Prognostics, Inc., and not for any other similar tests.

5. When to use CPT code 0247U

CPT code 0247U should be used when a clinician orders the PreTRM® test from Sera Prognostics, Inc., for women pregnant with a single child during the 19th or 20th week of pregnancy. This test helps predict the likelihood of spontaneous preterm birth, allowing for early identification of women at risk and appropriate preventive interventions. It is important to note that this code should not be used for any other similar tests or for different manufacturers.

6. Documentation requirements

To support a claim for CPT code 0247U, the following documentation is required:

• Documentation of the patient’s pregnancy status and gestation weeks (19th or 20th week)
• Documentation of the specific test ordered, which should be the PreTRM® test from Sera Prognostics, Inc.
• Date of service when the specimen was collected
• Results of the test, including the risk stratification score for spontaneous preterm birth
• Signature of the clinician who ordered the test

7. Billing guidelines

When billing for CPT code 0247U, ensure that the test performed is the PreTRM® test from Sera Prognostics, Inc. It is important to note that this code should not be reported for any other similar tests or for different manufacturers. Additionally, some payers may provide separate reimbursement for the collection of the specimen, so it is advisable to check with the appropriate payer for their specific requirements and guidelines.

8. Historical information

CPT code 0247U was added to the Current Procedural Terminology system on April 1, 2021. As of now, there have been no updates or changes to this code since its addition.

9. Examples

1. A clinician orders the PreTRM® test from Sera Prognostics, Inc., for a pregnant woman during the 19th week of gestation to assess the risk of spontaneous preterm birth.
2. A pregnant patient in her 20th week of gestation undergoes the PreTRM® test from Sera Prognostics, Inc., to determine the likelihood of preterm birth and allow for appropriate preventive interventions.
3. A clinician utilizes the PreTRM® test from Sera Prognostics, Inc., for a pregnant woman with a history of preterm birth during her 19th week of gestation to assess the risk of recurrence.
4. A pregnant patient with multiple risk factors for preterm birth undergoes the PreTRM® test from Sera Prognostics, Inc., during her 20th week of gestation to aid in early identification and intervention.
5. A clinician orders the PreTRM® test from Sera Prognostics, Inc., for a pregnant woman with a history of preterm birth and additional complications to assess the overall risk of spontaneous preterm birth.
6. A pregnant patient with no known risk factors undergoes the PreTRM® test from Sera Prognostics, Inc., during her 19th week of gestation to provide reassurance and monitor for any potential risks.
7. A clinician utilizes the PreTRM® test from Sera Prognostics, Inc., for a pregnant woman with a history of preterm birth and a high-risk pregnancy to guide appropriate management and interventions.
8. A pregnant patient with a history of preterm birth undergoes the PreTRM® test from Sera Prognostics, Inc., during her 20th week of gestation to assess the risk of recurrence and tailor her prenatal care accordingly.
9. A clinician orders the PreTRM® test from Sera Prognostics, Inc., for a pregnant woman with multiple risk factors for preterm birth during her 19th week of gestation to provide early identification and intervention.
10. A pregnant patient with no known risk factors undergoes the PreTRM® test from Sera Prognostics, Inc., during her 20th week of gestation to assess the overall risk of spontaneous preterm birth and ensure appropriate monitoring.