Pathology/Lab Coding Alert

Know where to find resequenced codes in CPT^® 2025.

The official 2025 CPT^® code set is out! Take your understanding of path/lab changes to the next level by focusing on code revisions, resequenced codes, and guideline updates.

Tip: See “Sneak a Peek at January 2025 CPT^® Path/Lab Changes,” in Pathology/Lab Coding Alert, Volume 25, Number 6, and “Get a Jump-Start on CPT^® 2025” in Volume 25, Number 8, for more information about coding changes effective Jan. 1, 2025.

Cut 3 Options From Genomic Sequence Codes

Prepare for major changes to genomic sequence codes 81432-81438. In 2024, you’ll find these codes:

• Hereditary breast cancer-related disorders: 81432 and 81433
• Hereditary colon cancer disorders: 81435 and 81436
• Hereditary neuroendocrine tumor disorders: 81437 and 81438

The 2025 update deletes 81433, 81436, and 81438, which apply to duplication/deletion analysis panels. New notes with the remaining codes tell you to assign 81479 (Unlisted molecular pathology procedure) in place of the deleted codes. Code 81479 is a resequenced code under 81408.

CPT^® revises the remaining codes, including changes to the numbers of genes required and the removal of required genes. Underlining indicates added text, and crossed out text will be deleted:

• 81432 (Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants; genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1,​ BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, and TP53)
• 81435 (Hereditary colon cancer-related disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants; genomic sequence analysis panel, must include sequencing of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11)
• 81437 (Hereditary neuroendocrine tumor-related disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants; genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL)

New parenthetical notes under the codes instruct you not to report these codes together. For instance, do not report 81437 with 81432 or 81435.

Add Antibiotic Resistance Testing Options

CPT^® 2025 adds 87513 (Helicobacter pylori (H. pylori), clarithromycin resistance, amplified probe technique). H. pylori is a bacteria that can infect the stomach and cause conditions like ulcers, and clarithromycin is an antibiotic. Notes under the code explain that 87513 is appropriate for assays that detect clarithromycin resistance and identify H. pylori using a single procedure. For amplified probe nucleic acid testing for H. pylori (without clarithromycin resistance testing), a note points you to 87798 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism).

CPT^® also adds 87564 (Mycobacterium tuberculosis, rifampin resistance, amplified probe technique). Again, “single procedure” is the key. You use 87564 for assays that detect resistance to the antibiotic rifampin and identify Mycobacterium tuberculosis using a single procedure.

Handle HPV Coding Like a Pro

In the microbiology section, don’t miss a revision and a new code for human papillomavirus (HPV) testing. The relevant codes are resequenced under 87539.

Watch for the addition of “pooled result” at the end of revised code 87624 (Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result). As in 2024, the 2025 code set tells you to use only 87624 when the provider tests both low-risk and high-risk HPV types in a single assay. A new note in the range also tells you to use 87624 for a singular pooled result of high-risk HPV types.

The new code is 87626 (Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)).

The code set still includes 87623 (Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44)) and 87625 (Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed). A new note tells you not to report 87626 together with 87624 and 87625 for the same procedure.

Understand Why 88387 Is ‘Revised’

Another change involves these surgical pathology codes:

• 88387 (Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies), each tissue preparation (eg, a single lymph node); each tissue preparation (eg, a single lymph node))
• +88388 (… in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure))

The 2025 code set deletes +88388 due to low use. Because 88387 will no longer share part of its descriptor with +88388, the 2025 code set changes the semicolon in 88387 (before “each tissue preparation”) to a comma.

You’ll also see a note accompanying the Surgical Pathology (above 88300) and Cytogenetic Studies (above 88230) codes telling you CPT^® has changed range references, so that the Surgical Pathology codes will now end with 88387 instead of +88388 now that the code has been deleted.

Factor In These 3 Final Updates

There is a new code for optical genome mapping: 81195 (Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM)). You’ll find this resequenced code in the middle of a group of other resequenced codes under 81229.

CPT^® updates a parenthetical note in the immunology section under 86155 (Chemotaxis assay, specify method). It continues to direct you to 86635 (Coccidioides) for coccidioides, antibodies, but the 2025 note no longer points you to 86490 (Skin test; coccidioidomycosis). CPT^® 2025 deletes 86490 because of low use.

The guidelines for Molecular Pathology revise the definition of cytogenomic. In 2024, the definition was “chromosome analysis using molecular techniques.” The expanded 2025 definition is “a comprehensive genome-wide analysis of chromosomal and genetic abnormalities using molecular-based technologies.”

Deborah Marsh, JD, MA, CPC, CHONC, Sr. Development Editor, AAPC