Pathology/Lab Coding Alert

Distinguish codes for similar tests.

When January 1 rolls around, you’ll need to know about three new oncology Multianalyte Assays with Algorithmic Analysis (MAAA) codes that CPT^® 2020 adds to the Category I pathology section.

Read on to learn about how the following three tests fit into the existing ecosystem of oncology testing.

• 81522 (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)
• 81542 (Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score)
• 81552 (Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis)

Master MAAA Basics

MAAA codes describe tests that use a panel of diagnostic procedures, then integrate the test results into an algorithm to provide a single “score” or probability for a specific prognostic outcome.

Each MAAA code involves all analytical services to produce test results that become the raw data for the algorithmic analysis. These technical lab services may include assays such as molecular testing for specific gene mutations or copy number errors, in situ hybridization (ISH), or chemistry lab tests. The code also includes gathering relevant patient data, carrying out the algorithmic analysis, and reporting the results.

Two locations: You’ll find Category I MAAA codes in the main section of the code set, but CPT^® also includes administrative MAAA codes in Appendix O. Administrative codes have four digits followed by the letter M, and might describe only one “proprietary” test performed by one lab or provided by one manufacturer. Appendix O also includes MAAA codes that are Proprietary Lab Analysis (PLA) codes that have four digits followed by the letter U.

Priority: If the MAAA test is proprietary, you must use the associated administrative or PLA code shown in Appendix O, which takes priority over any Category I code. Conversely, you should not use a proprietary code for any procedure other than the specified test.

Interpretation: MAAA codes include the algorithmic analysis that results in the reported risk score. You should never report an additional interpretation code, such as G0452 (Molecular pathology procedure; physician interpretation and report) with a MAAA code. “Use G0452 only when a pathologist interprets a Tier 1 or Tier 2 molecular pathology test,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Survey Breast Oncology Options

Clinicians use the analysis described by new code 81522 to evaluate formalin-fixed paraffin-embedded (FFPE) tumor tissue for an mRNA gene expression profile of 12 genes to calculate a risk score for breast cancer recurrence. The code describes a proprietary test: EndoPredict^®.

The new code joins the following four Category I codes for MAAA breast oncology tests:

• 81518 (Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy), proprietary test Breast Cancer Index by Biotheranostics, Inc.
• 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), proprietary test Oncotype DX^®
• 81520 (Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score), proprietary test Prosigna® Breast Cancer Assay
• 81521 (Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis), proprietary test MammaPrint^®

Make sure you consider these other code descriptors, as well as several PLA codes for breast oncology MAAA tests, to ensure that you assign the correct code.

Compare Prostate Oncology Tests

Clinicians may order 81542 to evaluate formalin-fixed paraffin-embedded (FFPE) prostate tumor tissue for an mRNA gene expression profile of 22 genes, and establish a risk score for metastatic prostate cancer.

This new code joins the following three Category I codes for MAAA prostate oncology tests:

• 81539 (Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 [hK2]), utilizing plasma or serum, prognostic algorithm reported as a probability score), proprietary test 4Kscore test by OPKO Health, Inc.
• 81541 (Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score), proprietary test Polaris^®
• 81551 (Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy), proprietary test ConfirmMDx^®

Compare these other code descriptors, as well as several PLA codes for prostate oncology MAAA tests, to ensure that you assign the correct code.

Transition Uveal Melanoma Test

Prior to CPT^® 2020, one PLA code was available to describe a MAAA test for uveal melanoma: 0081U (Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis).

This year, CPT^® deletes 0081U and replaces it with new code 81552 with the same definition. The proprietary test is DecisionDx^® UM Test by Castle Biosciences, Inc.