How To Use CPT Code 0313U

CPT 0313U describes a proprietary laboratory analysis (PLA) test called PancreaSeq® Genomic Classifier. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0313U?

CPT 0313U is a specific code used to identify the PancreaSeq® Genomic Classifier test. This test is a proprietary laboratory analysis (PLA) that is performed by the University of Pittsburgh Medical Center Molecular and Genomic Pathology Laboratory. It involves the analysis of pancreatic cyst fluid using next-generation sequencing (NGS) of 74 genes and gene expression analysis of the CEA (CEACAM5) gene. The test provides a categorical result, indicating the probability of neoplasia (cancer) in the cyst.

2. Official Description

The official description of CPT code 0313U is: ‘Oncology (pancreas), DNA and mRNA next-generation sequencing analysis of 74 genes and analysis of CEA (CEACAM5) gene expression, pancreatic cyst fluid, algorithm reported as a categorical result (ie, negative, low probability of neoplasia or positive, high probability of neoplasia).’

3. Procedure

1. The PancreaSeq® Genomic Classifier test is performed using fluid obtained from a pancreatic cyst, typically through endoscopic ultrasound fine needle aspiration (EUS-FNA).
2. The laboratory analyst uses next-generation sequencing (NGS) to analyze the DNA and mRNA of 74 genes in the cyst fluid.
3. The test also includes analysis of the gene expression of the CEA (CEACAM5) gene, which is a biomarker for gastrointestinal cancers.
4. An algorithmic analysis is performed on the genetic findings to determine the categorical result of the test, indicating the probability of neoplasia (cancer) in the pancreatic cyst.

4. Qualifying circumstances

CPT code 0313U is used for patients who require analysis of pancreatic cyst fluid to assess the probability of neoplasia (cancer) in the cyst. The test is specifically designed for patients with pancreatic cysts and is not applicable to other conditions or body sites. It is important to note that this test is only performed by the University of Pittsburgh Medical Center Molecular and Genomic Pathology Laboratory and should not be used for tests performed by other laboratories.

5. When to use CPT code 0313U

CPT code 0313U should be used when a patient requires analysis of pancreatic cyst fluid to determine the probability of neoplasia (cancer) in the cyst. This test is specifically designed for patients with pancreatic cysts and should not be used for other conditions or body sites. It is important to ensure that the test is performed by the University of Pittsburgh Medical Center Molecular and Genomic Pathology Laboratory.

6. Documentation requirements

To support a claim for CPT code 0313U, the following documentation is required:

• Documentation indicating the need for analysis of pancreatic cyst fluid
• Results of the next-generation sequencing (NGS) analysis of the 74 genes
• Results of the gene expression analysis of the CEA (CEACAM5) gene
• The categorical result of the algorithmic analysis
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT code 0313U, it is important to ensure that the test is performed by the University of Pittsburgh Medical Center Molecular and Genomic Pathology Laboratory. This is a proprietary laboratory analysis (PLA) code, and it should only be used for the PancreaSeq® Genomic Classifier test. It is not appropriate to report this test using any other CPT code. Additionally, it is important to follow any specific billing guidelines provided by the laboratory.

8. Historical information

CPT code 0313U was added to the Current Procedural Terminology system on April 1, 2022. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes the PancreaSeq® Genomic Classifier test to assess the probability of neoplasia (cancer) in a pancreatic cyst identified through imaging.
2. A physician orders the PancreaSeq® Genomic Classifier test for a patient with a pancreatic cyst to determine the need for further intervention or monitoring.
3. A patient with a pancreatic cyst undergoes the PancreaSeq® Genomic Classifier test to guide treatment decisions and prognosis.
4. A gastroenterologist performs the PancreaSeq® Genomic Classifier test on a patient with a pancreatic cyst to assess the risk of progression to pancreatic ductal adenocarcinoma.
5. A patient with a pancreatic cyst undergoes the PancreaSeq® Genomic Classifier test to determine the appropriate surveillance and management plan.
6. A surgeon orders the PancreaSeq® Genomic Classifier test for a patient with a pancreatic cyst to assess the need for surgical intervention.
7. A patient with a pancreatic cyst undergoes the PancreaSeq® Genomic Classifier test to provide additional information for genetic counseling and family planning.
8. A gastroenterologist performs the PancreaSeq® Genomic Classifier test on a patient with a pancreatic cyst to guide the selection of targeted therapies.
9. A patient with a pancreatic cyst undergoes the PancreaSeq® Genomic Classifier test to assess the risk of malignant transformation.
10. A physician orders the PancreaSeq® Genomic Classifier test for a patient with a pancreatic cyst to determine the appropriate follow-up and monitoring schedule.