Pathology/Lab Coding Alert

Check Appendix O for more codes.

New Multianalyte Assays with Algorithmic Analysis (MAAA) tests range from microbiology to oncology; and from Category I codes, to administrative codes, to Proprietary Laboratory Analyses (PLA) codes.

Let our experts help you make sense of this variety to ensure that you correctly report these services in 2021.

Look for Category I Revisions

You need to get familiar with one deletion and five new codes in the CPT^® 2021 MAAA section, including the following two new codes:

• 81529 (Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis)
• 81554 (Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm reported as categorical result (eg, positive or negative for high probability of usual interstitial pneumonia [UIP]))

BV: You also have two new codes for bacterial vaginosis. Code 81513 (Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis) describes a test originally developed by Hologic, Inc. as the Aptima^® BV Assay. The test identifies RNA markers for three common bacterial species in a vaginal swab and performs an algorithmic analysis of the balance of “good” versus “bad” bacteria to report the specimen as positive or negative for bacterial vaginosis, according to Paul W. Radensky, M.D. J.D., with McDermott+ Consulting, speaking for Hologic at the Clinical Laboratory Fee Schedule (CLFS) annual public meeting in 2020.

Code 81514 (Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported) describes a test originally developed by Becton Dickson and Company as the BDMAX™ Vaginal Panel, which interrogates multiple DNA targets for bacterial, fungal, and parasite targets from a single patient vaginal specimen and reports the findings as positive or negative for high likelihood of bacterial vaginosis, according to Celine Roger-Dalbert, speaking for BD at the CLFS annual public meeting for 2021 codes.

Thyroid oncology: New code 81546 (Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)) replaces deleted code 81545 (Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)) for a similar Afirma^® test developed by Veracyte, Inc that has a different gene count for mRNA gene expression in a thyroid fine needle aspirate (FNA), with algorithmic analysis reported as benign or suspicious for thyroid cancer. The assay is valuable as a pre-op genomic test for an indeterminant thyroid biopsy, according to John Hanna, speaking for Veracyte at the CLFS annual public meeting for 2021 codes.

You’ll need to distinguish new code 81546 from similar PLA codes for thyroid cancer MAAA codes using an FNA specimen, such as 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) and 0026U (Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result (“Positive, high probability of malignancy” or “Negative, low probability of malignancy”)).

Greet 3 Administrative MAAA Codes

CPT^® 2021 introduces the following three new administrative codes in Appendix O for MAAA and PLA codes:

• 0014M (Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino terminal peptide [PIIINP], tissue inhibitor of metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years)
• 0015M (Adrenal cortical tumor, biochemical assay of 25 steroid markers, utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other adrenal malignancy)
• 0016M (Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)

Contrast new code 0014M that describes a test for three biomarkers for algorithmic prediction of liver fibrosis with existing code 0003M (Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin, AST, glucose, total cholesterol and triglycerides) utilizing serum, prognostic algorithm reported as quantitative scores for fibrosis, steatosis and nonalcoholic steatohepatitis (NASH)). The new test focuses on liver fibrosis as “the most important histological feature associated with mortality in NASH, regardless of the presence or severity of other histologic features,” according to Katherine Soreng, presenting for Siemens Healthineers at the annual CLFS meeting for new 2021 codes. Accurate early identification of liver fibrosis can identify candidates for anti-fibrotic agents to treat certain cases of liver disease.

Understand MAAA Code Placement

Don’t let the various categories for MAAA codes confuse you. You need to know where to find the code numbers, definitions, and proprietary lab names within the CPT^® code book.

Definition: 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. You should not separately or additionally report any of those three components: the analytical test, the algorithmic interpretation, or the report.

Categories: You’ll find MAAA codes in three places within CPT^®:

• First, look in the MAAA section of Category I codes numbered 81490-81599.
• Next, “If a specific MAAA procedure has not been assigned a Category I code, it is indicated [in Appendix O] as a four-digit number followed by the letter M,” according to the CPT^® Appendix O introduction.
• Finally, some, but not all, PLA codes describe MAAA tests. You’ll find the PLA codes in the final section of the Pathology and Laboratory chapter in the CPT^® code book, numbered 0001U-0222U. Appendix O now also includes a complete listing of PLA codes, whether or not the analysis is a MAAA procedure.

Proprietary name: Appendix O lists the proprietary name for each MAAA and other PLA procedure. 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.

Periodic release: The AMA releases administrative MAAA codes and PLA codes on a more frequent schedule than most other CPT^® codes. You can follow the updates at www.ama-assn.org/practice-management/cpt/multianalyte-assays-algorithmic-analyses-codes and www.ama-assn.org/practice-management/cpt/cpt-pla-codes.