Pathology/Lab Coding Alert

Expect MAAA and microbiology changes, too.

We have the scoop on new 2020 clinical laboratory test codes you need to know. Read on for your sneak peek based on our rundown of the CMS Annual Clinical Laboratory Public Meeting held June 24, 2019.

Remember: The 2020 CPT^® codes aren’t finalized, but CMS provided the new codes for stakeholder comment at the meeting. The open meeting is part of the process to determine the basis of payment for the codes, according to CMS’s meeting facilitator, Rasheeda Arthur, PhD.

Greet New Category I Codes

You’ll find the following new molecular pathology and cytogenetics codes in CPT^® 2020, according to the list provided at the meeting:

• 813X1 (PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence)
• 813X2 (… known familial variant)
• 8XX01 (PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg, colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, and 20)
• 8XX0X (Cytogenomic neoplasia (genome-wide) microarray analysis, interro­gation of genomic regions for copy number and loss-of-heterozygosity variants for chromosomal abnormalities).

Anticipate new multianalyte assays with algorithmic analyses (MAAA) codes in 2020, as follows:

• 8XX03 (Oncology (uveal melanoma), mRNA, gene-expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping genes), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis)
• This test used to have a PLA code (0081U), but will transition to a Category I MAAA code (8XX03) effective Jan. 1, 2020, according to Federico Monzon, presenting for Castle Biosciences at the CMS annual meeting.
• 815X0 (Oncology (breast), mRNA gene expression profiling by RT-PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk score)
• 815XX (Oncology (prostate), mRNA microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score).

Chemistry: CPT^® 2020 will include the following new chemistry codes:

• 80XX0 (Adalimumab)
• 80XX1 (Infliximab)
• 80XX2 (Lacosamide)
• 802X0 (Posaconazole)
• 802XX (Vedolizumab)
• 802X1 (Voriconazole).

You’ll also find one new microbiology code next year: 8XXXX (Infectious agent o by nucleic acid (DNA or RNA); Mycoplasma genitalium, amplified probe technique).

Expect Abundant PLA Code Additions

Introduced to CPT^® in 2018, the Proprietary Laboratory Analyses (PLA) 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.

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).

At the June 24 public meeting, CMS heard stakeholder comments about pricing for nearly 40 new PLA codes (0062U - 0103U). Here’s a quick peek at the variety of analyses addressed by various PLA codes:

Neoplasm: Many of the tests target diagnosis, prognosis, or treatment indications for cancers such as colorectal (0069U, 0101U, 0111U, 0130U), prostate (0113U, 0133U), breast (0067U, 0102U, 0129U, 0131U, 0138U), lung (0092U), melanoma (0089U,0090U), ovarian (0103U, 0132U), and other oncology (0083U, 0134U, 0135U).

Drug testing: Several new PLA codes (0070U-0076U) focus on CYP2D6 gene analysis to identify variants that may interfere with drug metabolism for medications such as tamoxifen, codeine, tramadol, and some antidepressants and antipsychotics. Other PLA codes for drug testing include 0078U, 0082U, 0093U, 0110U, 0116U, and 0117U.

Infectious agent: Many new PLA codes target infectious agents, such as the following:

• Treponema pallidum (syphilis) – 0064U, 0065U
• Infectious agent identification 0086U, 0112U
• Human papilloma virus (HPV) – 0096U
• Respiratory pathogen(s) – 0098U, 0099U, 0100U, 0115U
• Clostridium difficile – 0107U
• Aspergillus – 0109U.

Transfusion and transplant: New PLA codes to assist blood transfusion and tissue transplant success include 0084U, 0087U, 0088U, 0118U, and 0123U.

Systems pathology: For Barrett’s esophagus and other related concerns you’ll find PLA codes 0095U, 0108U, and 0114U. For gastric emptying see 0106U; for chronic kidney disease see 0105U; and for cardiology risk see 0119U.

Obstetrics: For a pre-term labor test (PAMG-1), see 0066U, and for preeclampsia assays see 0127U and 0128U. New PLA codes for fetal congenital abnormalities include 0124U, 0125U, and 0126U.

Heritable disease: New PLAs provide rapid sequence analysis for unexplained constitutional disorders (0094U) and two new codes for sickle cell disease (0121Uand 0122U).

To read more about PLA codes, including how to apply for a code, and for a current list of AMA approved codes, visit  www.ama-assn.org/practice-management/cpt/cpt-pla-codes.