Pathology/Lab Coding Alert

See how new codes impact pay.

Targeted genomic sequence panels for solid organ or blood/lymph (hematolymphoid) cancers get a makeover in CPT® 2023, effective Jan. 1.

Here’s a rundown of the three revised and three new codes, along with insight about how the changes will impact your billing and reimbursement.

Parse the Meaning of Three Code Revisions

You need to know the following three revised codes for CPT^® 2023:

• 81445 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis)
• 81450 (Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis)
• 81455 ( Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis)

Each code descriptor update includes the following three changes:

• CPT^® corrects the alphabetic order of the parenthetical “for example” (eg) gene list, without adding or omitting any genes.
• CPT^® deletes the phrase “DNA analysis, and RNA analysis when performed,” as it’s placed in the 2022 code descriptor.
• CPT^® makes each code a parent code by adding “; DNA analysis or combined DNA and RNA analysis” to the end of each code descriptor.

The revisions provide some “change in verbiage … but it’s essentially the same procedure and there’s no change in how the procedure is done,” according to Jan A. Nowak MD, PhD, FCAP, representingThe College of American Pathologists in his presentation at the Clinical Laboratory Fee Schedule (CLFS) annual meeting earlier this year.

Note: CPT^® 2023 also adds the phrase “or isoform expression or mRNA expression levels” to 81455. Adding the phrase to the 81455 code for 51 or more genes relevant to solid tumor or hematolymphoid neoplasia parallels the 81450 code for 5-50 genes for hematolymphoid neoplasia.

Greet 3 New ‘Child’ Codes

Under each of the revised “parent” codes, 81445, 81450, and 81455, CPT^® 2023 places a “child” code.

Recall: A child code in CPT^® shares all of the code descriptor preceding the semicolon (;) in the parent code, says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia.

Here are the three new codes for 2023:

• 81449 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis)
  o This is the child code under revised 81445.
• 81451 (Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
  o This is the child code under revised code 81450.
• 81456 (Targeted genomic sequence analysis panel, solid organ or hemato­lymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
  o This is the child code under revised code 81455.

When CPT^® created the three parent codes, the original descriptors were for DNA analysis only. As lab testing evolved and some labs also performed RNA analysis, CPT^® revised the codes to add “and RNA analysis when performed.” Now labs may

perform RNA analysis alone, apart from DNA analysis. For that reason, “there was a need to have a separate code for RNA distinct from DNA,” Nowak explained in his presentation.

Bottom line: The three new codes are RNA-specific versions of their respective parent code. Your lab should report the appropriate parent code for a genomic DNA or DNA+RNA panel, but report the appropriate child code for an RNA-only panel.

Payment impact: The Centers for Medicare & Medicaid Services (CMS) has posted the proposed payment levels for the three new codes based on stakeholder input at the annual CLFS meeting. For each new code, CMS proposes crosswalking payment to the parent code. That means your lab can expect the same pay for these targeted genomic panels whether the lab evaluates DNA, RNA, or both. CMS should finalize the basis of payment for the new codes before Jan. 1. You can find the proposed payment levels at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings, scroll down to CY 2023 CLFS preliminary payment determinations.

Current payment for the three parent codes is as follows (2022 CLFS national payment amount):

• 81445: $597.91
• 81450: $759.53
• 81455: $2919.60