How To Use CPT Code 81313

CPT 81313 describes the evaluation of the ratio between two genes, PCA3 and KLK3, for the diagnosis and monitoring of prostate cancer. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81313?

CPT 81313 can be used to evaluate the ratio between two genes, PCA3 and KLK3, to aid in the diagnosis and monitoring of prostate cancer. This code is used when a lab analyst performs the technical lab test to measure the proportion of PCA3 with respect to KLK3. The evaluation of this ratio can confirm the diagnosis of prostate cancer in nearly all patients, although additional tests may be necessary to evaluate the genetic status and confirm the diagnosis.

2. Official Description

The official description of CPT code 81313 is: ‘PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer)’

3. Procedure

1. The lab analyst performs the technical lab test to evaluate the ratio between PCA3 and KLK3 genes.
2. The lab analyst extracts the nucleic acids from the sample using methods such as cell lysis and digestion.
3. The lab analyst amplifies and stabilizes the quantity of nucleic acid for analysis.
4. The lab analyst detects the target genes, PCA3 and KLK3, using methods such as nucleic acid probes.
5. The lab analyst measures the proportion of PCA3 with respect to KLK3 to determine the ratio.

4. Qualifying circumstances

CPT 81313 is commonly ordered by clinicians to confirm a clinical diagnosis and monitor prostate cancer. It is not limited to testing for a specific condition, but it is primarily used for the evaluation of the PCA3/KLK3 ratio. Prostate cancer may cause symptoms such as difficulty in urination, blood in urine, pain in the pelvis, and fatigue due to low red blood cell levels.

5. When to use CPT code 81313

CPT code 81313 should be used when evaluating the ratio between PCA3 and KLK3 genes for the diagnosis and monitoring of prostate cancer. It is appropriate to bill this code when the lab analyst performs the technical lab test to measure the proportion of PCA3 with respect to KLK3. This code should not be used for testing unrelated to prostate cancer or when evaluating other genetic markers.

6. Documentation requirements

To support a claim for CPT 81313, the documentation should include:

• Reason for ordering the test, such as confirming a clinical diagnosis or monitoring prostate cancer
• Details of the technical lab test performed, including the evaluation of the PCA3/KLK3 ratio
• Date and time of the test
• Results of the test, including the measured ratio
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81313, ensure that the test is performed by a lab analyst and that the evaluation is specifically for the PCA3/KLK3 ratio. This code should not be reported with other codes unless there are separate prep work procedures documented. It is important to follow the specific guidelines provided by the payer and to use the appropriate modifiers if required.

8. Historical information

CPT 81313 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst evaluating the PCA3/KLK3 ratio for a patient with suspected prostate cancer.
2. A clinician ordering CPT 81313 to monitor the progression of prostate cancer in a patient.
3. A lab analyst performing the technical lab test to confirm the diagnosis of prostate cancer based on the PCA3/KLK3 ratio.
4. A patient undergoing the evaluation of the PCA3/KLK3 ratio as part of a prostate cancer screening program.
5. A clinician using CPT 81313 to assess the response to prostate cancer treatment based on changes in the PCA3/KLK3 ratio.
6. A lab analyst measuring the PCA3/KLK3 ratio to differentiate between benign prostatic hyperplasia and prostate cancer.
7. A patient with a family history of prostate cancer undergoing the evaluation of the PCA3/KLK3 ratio as a preventive measure.
8. A clinician ordering CPT 81313 to determine the risk of prostate cancer recurrence based on the PCA3/KLK3 ratio.
9. A lab analyst performing the technical lab test to evaluate the PCA3/KLK3 ratio in a patient with an indeterminate prostate biopsy result.
10. A patient with elevated prostate-specific antigen levels undergoing the evaluation of the PCA3/KLK3 ratio to aid in the diagnosis of prostate cancer.