Pathology/Lab Coding Alert

Examine a wide range of new oncology tests.

If you don’t keep up with the AMA quarterly updates for proprietary laboratory analyses (PLA), you have a lot to learn when the calendar turns to Jan. 1. That’s when CPT^® 2023 publishes nearly 70 new PLA codes, although many of the codes have been active for various periods of time throughout 2022.

More than 30 of those PLA codes deal with testing for oncology. With that cancer-testing focus, here’s a roundup of some of the codes, along with information about the codes’ effective dates.

Correctly Place PLA Codes in the CPT^® Universe

PLA codes “describe proprietary clinical laboratory analyses that can be provided either by a single (“sole source”) laboratory or licensed or marketed to multiple providing laboratories (eg, cleared or approved by the FDA),” according to CPT^®. In other words, each PLA code is unique to a commercial test made by a specific manufacturer.

Where to find them: You’ll find the PLA codes at the end of the Pathology and Laboratory CPT^® section in numerical order (four digits followed by the letter “U,” sometimes referred to as “U codes”). But you’ll also find the PLA codes in AMA CPT^® Appendix O, where, in addition to the code descriptor, you’ll find the proprietary name for the test.

That’s important because CPT^® guidelines state, “In order to report a PLA code, the analysis performed must fulfill the code descriptor and must be the test represented by the proprietary name listed in Appendix O.”

Precedence: CPT^® guidelines tell you that “when a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. The service should not be reported with any other CPT^® code(s) and other CPT^® code(s) should not be used to report services that may be reported with that specific PLA code.”

Know These New CPT^® 2023 Oncology PLA Codes

Tests for specific types of cancer, pan cancer, chemotherapy response, and more, populate the new PLA codes in the annual CPT^® update. The tests range from genomic analysis panels to biomarker panels to Multianalyte Assays with Algorithmic Analyses (MAAAs).

MRD: For instance, you’ll find the following three codes for minimal residual disease (MRD):

• 0306U (Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis, cell-free DNA, initial (baseline) assessment to determine a patient-specific panel for future comparisons to evaluate for MRD)
• 0307U (…subsequent assessment with comparison to previously analyzed patient specimens to evaluate for MRD)
• 0340U (Oncology (pan-cancer), analysis of minimal residual disease (MRD) from plasma, with assays personalized to each patient based on prior next-generation sequencing of the patient’s tumor and germline DNA, reported as absence or presence of MRD, with disease-burden correlation, if appropriate)

Pan Cancer: Also look for the following pan cancer genome and exome mapping tests to evaluate many types of neoplasm:

• 0297U-0300U (Oncology (pan tumor), … sequencing of paired malignant and normal … specimens …)
• 0334U (Oncology (solid organ), targeted genomic sequence analysis, formalin-fixed paraffin-embedded (FFPE) tumor tissue, DNA analysis, 84 or more genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden).
• 0329U (Oncology (neoplasia), exome and transcriptome sequence analysis for sequence variants, gene copy number amplifications and deletions, gene rearrangements, microsatellite instability and tumor mutational burden utilizing DNA and RNA from tumor with DNA from normal blood or saliva for subtraction, report of clinically significant mutation(s) with therapy associations)
• 0326U (Targeted genomic sequence analysis panel, solid organ neoplasm, cell-free circulating DNA analysis of 83 or more genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden)

“The 0326U test is approved as a comprehensive liquid biopsy for all advanced solid tumors,” notes Kelly Loya, CPC, CHC, CRMA, CPhT, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina.

Treatment response: Several new codes interrogate response to therapy for many types of cancer, such as 0285U (… response to radiation …) and 0332U (… probability of responding to immune checkpoint-inhibitor therapy).

Briefly, here are other new codes (without descriptors) for skin cancer gene [removed]0314U and 0315U), ovarian cancer chemotherapy response (0324U, 0325U), and thyroid (0208U, 0287U), lung (0288U, 0317U), breast (0295U), oropharyngeal (0296U), pancreatic (0313U, 0342U), prostate (0339U, 0343U), and colorectal (0229U) cancer.

See What PLA Tests Include

The services described by PLA codes include all lab technical work and materials, and for tests that include an algorithm such as MAAA tests, the codes “encompass all analytical services required for the algorithmic analysis,” according to CPT^® guidance. However, if the test requires specimen processing prior to extraction of nucleic acids for testing, the processing is not included.

Regarding processing, “You can report additional procedures prior to cell lysis for molecular analyses separately,” notes Leah Fuller, CPC, COC, senior consultant, Pinnacle Enterprise Risk Consulting Services, in Charlotte, North Carolina. For example, for tests that require microdissection to obtain a cell sample for testing purposes, you may report the microdissection separately using either 88380 (Microdissection (ie, sample preparation of microscopically identified target); laser capture) or 88381 (… manual) as appropriate for the method of obtaining the specimen.

To see a full and current list of PLA codes, go to www.ama-assn.org/practice-management/cpt/cpt-pla-codes.