Question
A comprehensive cardiomyopathy panel is ordered for a patient. The panel consists of next generation sequencing and duplication/deletion of the following genes.
A2ML1, ABCC9, ACADVL, ACTC1, ACTN2, ADA2, AGL, AKAP9, ALMS1, ANK2, ANKRD1, BAG3, BRAF, CACNA1C, CACNB2, CALR3, CASQ2, CAV3, CAVIN4, CBL, CHRM2, CPT2, CRYAB, CSRP3, CTF1, CTNNA3, DES, DMD, DNAJC19, DOLK, DSC2, DSG2, DSP, DTNA, ELAC2, EMD, EYA4, FHL1, FHL2, FKRP, FKTN, FLNC, FXN, GAA, GATA4, GATA6, GATAD1, GLA, GPD1L, HCN4, HRAS, ILK, JPH2, JUP, KCNE1, KCNE2, KCNE3, KCNH2, KCNJ2, KCNJ5, KCNJ8, KCNQ1, KRAS, LAMA4, LAMP2, LDB3, LMNA, MAP2K1, MAP2K2, MIB1, MTO1, MYBPC3, MYH6, MYH7, MYL2, MYL3, MYLK2, MYOM1, MYOZ2, MYPN, NDUFB11, NEBL, NEXN, NF1, NKX2-5, NPPA, NRAS, PDLIM3, PKP2, PLN, PRDM16, PRKAG2, PTPN11, RAF1, RANGRF, RASA1, RBM20, RIT1, RRAS, RYR2, SCN1B, SCN3B, SCN4B, SCN5A, SDHA, SGCD, SHOC2, SLC22A5, SNTA1, SOS1, SOS2, SPRED1, TAZ, TBX20, TCAP, TGFB3, TMEM43, TMEM70, TMPO, TNNC1, TNNI3, TNNT2, TPM1, TRDN, TTN, TTR, TXNRD2, VCL, YWHAE
Specific to molecular pathology procedures, NCCI, Chapter 10, section f.8. states: If one laboratory procedure evaluates multiple genes using a next generation sequencing procedure, the laboratory should report only one unit of service of one genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis or proprietary laboratory analysis CPT code. If no CPT code accurately describes the procedure performed, the laboratory may report CPT code 81479 with one unit of service or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary.
Based on our interpretation of the above NCCI guideline (‘or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary’), we should be able to bill for the applicable genomic sequencing panels for the relevant subsets of genes (i.e. 81442, 81413, 81439) and tier 2 CPTs as applicable for the rest of the genes not included in the genomic sequencing panel CPTs. However, we’ve also been made aware of the need to only bill 1 CPT code describing the genomic sequencing panel. If so, we are looking to bill CPTs 81442 to represent the genomic sequencing panel and 81414 for the deletion/ duplication analysis.
Would this comply with the coding guidelines? Any other alternatives for consideration?
A comprehensive cardiomyopathy panel is ordered for a patient. The panel consists of next generation sequencing and duplication/deletion of the following genes.
A2ML1, ABCC9, ACADVL, ACTC1, ACTN2, ADA2, AGL, AKAP9, ALMS1, ANK2, ANKRD1, BAG3, BRAF, CACNA1C, CACNB2, CALR3, CASQ2, CAV3, CAVIN4, CBL, CHRM2, CPT2, CRYAB, CSRP3, CTF1, CTNNA3, DES, DMD, DNAJC19, DOLK, DSC2, DSG2, DSP, DTNA, ELAC2, EMD, EYA4, FHL1, FHL2, FKRP, FKTN, FLNC, FXN, GAA, GATA4, GATA6, GATAD1, GLA, GPD1L, HCN4, HRAS, ILK, JPH2, JUP, KCNE1, KCNE2, KCNE3, KCNH2, KCNJ2, KCNJ5, KCNJ8, KCNQ1, KRAS, LAMA4, LAMP2, LDB3, LMNA, MAP2K1, MAP2K2, MIB1, MTO1, MYBPC3, MYH6, MYH7, MYL2, MYL3, MYLK2, MYOM1, MYOZ2, MYPN, NDUFB11, NEBL, NEXN, NF1, NKX2-5, NPPA, NRAS, PDLIM3, PKP2, PLN, PRDM16, PRKAG2, PTPN11, RAF1, RANGRF, RASA1, RBM20, RIT1, RRAS, RYR2, SCN1B, SCN3B, SCN4B, SCN5A, SDHA, SGCD, SHOC2, SLC22A5, SNTA1, SOS1, SOS2, SPRED1, TAZ, TBX20, TCAP, TGFB3, TMEM43, TMEM70, TMPO, TNNC1, TNNI3, TNNT2, TPM1, TRDN, TTN, TTR, TXNRD2, VCL, YWHAE
Specific to molecular pathology procedures, NCCI, Chapter 10, section f.8. states: If one laboratory procedure evaluates multiple genes using a next generation sequencing procedure, the laboratory should report only one unit of service of one genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis or proprietary laboratory analysis CPT code. If no CPT code accurately describes the procedure performed, the laboratory may report CPT code 81479 with one unit of service or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary.
Based on our interpretation of the above NCCI guideline (‘or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary’), we should be able to bill for the applicable genomic sequencing panels for the relevant subsets of genes (i.e. 81442, 81413, 81439) and tier 2 CPTs as applicable for the rest of the genes not included in the genomic sequencing panel CPTs. However, we’ve also been made aware of the need to only bill 1 CPT code describing the genomic sequencing panel. If so, we are looking to bill CPTs 81442 to represent the genomic sequencing panel and 81414 for the deletion/ duplication analysis.
Would this comply with the coding guidelines? Any other alternatives for consideration?