Oncology & Hematology Coding Alert

Overlooking these breast cancer revisions could impact your bottom line.

One molecular pathology code explodes into a bevy of detailed options as of Jan. 1, and so you've got to be certain what code to report when your oncologists orders a specific clinical lab genetic test.

"These codes were previously bundled into one molecular pathology code," says Kelly Loya, CPhT, CPC-I, CHC, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services.

Go Through This List of Detailed Lab Services

Check out these new specific codes:

• 81105 (Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P)
• 81106 (... Antigen 2 genotyping (HPA-2) ...)
• 81107 (... Antigen 3 genotyping (HPA-3) ...)
• 81108 (... Antigen 4 genotyping (HPA-4) ...)
• 81109 (... Antigen 5 genotyping (HPA-5) ...)
• 81110 (... Antigen 6 genotyping (HPA-6w) ...)
• 81111 (... Antigen 9 genotyping (HPA-9w) ...)
• 81112 (... Antigen 15 genotyping (HPA-15) ...)

IDH1 codes:

• 81120 (IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C))
• 81121 (IDH2 ...)

ASXL1 codes:

• 81175 (ASXL1 (additional sex combs like 1, transcrip­tional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence)
• 81176 (... targeted sequence analysis (eg, exon 12))

Additionally, you have these new codes:

• 81230 (CYP3A4 (cytochrome P450 family 3 subfamily A member 4) ...)
• 81231 (CYP3A5 (cytochrome P450 family 3 subfamily A member 5) ...)
• 81232 (DPYD (dihydropyrimidine dehydrogenase) ...)
• 81238 (F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence)

G6PD codes:

• 81248 (G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s))
• 81249 (... full gene sequence)

HBA1/HBA2 codes:

• 81258 (HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant)
• 81259 (...full gene sequence)
• 81269 (... duplication/deletion variants)

Plus, you need to learn these codes:

• 81283 (IFNL3 (interferon, lambda 3) ...)
• 81328 (SLCO1B1 (solute carrier organic anion transporter family, member 1B1) ...)
• 81334 (RUNX1 (runt related transcription factor 1) ...)
• 81335 (TPMT (thiopurine S-methyltransferase) ...)
• 81346 (TYMS (thymidylate synthetase) ...)

HBB codes:

• 81361 (HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE))
• 81362 (... known familial variant(s))
• 81363 (...duplication/deletion variant(s))
• 81364 (... full gene sequence)

And finally, this code:

• 81448 (Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1)

Master New MAAA Codes Before Next Year

Also, prepare for four new Multianalyte Assay with Algorithmic Analysis (MAAA) codes next year, as follows:

• Two codes (81520 and 81521) for breast cancer mRNA gene expression using formalin-fixed paraffin-embedded tissue; one test reports a recurrence risk score, one test reports an index related to risk of distant metastasis
• Two codes (81541 and 81551) for prostate cancer using formalin-fixed paraffin-embedded tissue; one test reports a disease-specific mortality risk score, one test reports the likelihood of prostate cancer detection on repeat biopsy.

Don't Forget These U Code Additions

CPT^® 2018 will include a new section listing codes for Proprietary Laboratory Analyses (PLA). These are alpha-numeric codes assigned with approval by the AMA CPT^® Editorial Panel for unique lab tests that a specific clinical laboratory or test manufacturer produces or provides. The lab or manufacturer may apply for a code, with new codes released quarterly.

PLAs may be Advanced Diagnostic Laboratory Tests (ADLTs) or Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA). Many of the tests may be for MAAAs or GSPs, but the PLA codes may include other types of medical laboratory tests.

You'll need to add the following "U" codes to your coding cache:

• 0018U (Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy)
• 0019U (Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents)
• 0021U (Oncology (prostate), detection of 8 autoan­tibodies (ARF 6, NKX3-1, 5'-UTR-BMI1, CEP 164, 3'-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score)
• 0022U (Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider)
• 0023U (Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin)

Finally, Don't Miss These Breast Cancer Revisions

Don't miss these pathology breast cancer revisions. Here are the revised descriptors:

• 81432 (Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic » sequence analysis panel, must include sequencing of at least 14 genes, including ATM, BRCA1, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, and TP53)
• 81519 (Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score)