Pathology/Lab Coding Alert

Plus, know where to find the latest PLA and MAAA code updates.

Pathology and laboratory services are constantly evolving, and that means you can count on coding changes coming your way. Get a head start on your Jan. 2025 update prep with this look ahead, and discover what’s happening with Proprietary Laboratory Analyses (PLA) and Multianalyte Assays With Algorithmic Analyses (MAAA), too.

Be the First to Learn January 2025 Changes

If you know where to look, you can get hints of code changes months before they’re official. The CPT^® Editorial Panel meets several times each year, and summaries of the panel’s actions are on the AMA website at www.ama-assn.org/about/cpt-editorial-panel/summary-panel-actions.

These summaries include placeholder codes (incomplete codes that provide an idea of a new code’s final location), and there may be changes before the updates are official, but the information can still help you prepare. Here are some updates you may see in the January 2025 CPT^® code set.

Resistance testing: As far back as the September 2023 meeting, the panel accepted the addition of two codes to report resistance testing for two specific organisms. The placeholder codes are 8X050 and 8X051.

Amyloid protein: The panel discussed the remaining updates at the February 2024 meeting. The first two accepted codes are 82XX0 and 82XX1, which you can expect to report for testing for amyloid beta 1-40 and 1-42. These peptides (portions of a larger protein) may be studied in connection with conditions like Alzheimer’s disease. The 82XXX placeholders suggest these codes will be in the Chemistry section.

Tau protein: The panel also accepted 8X3X0 for phosphorylated tau protein and 8X3XX for total tau protein. Phosphorylation is the process of adding a phosphate group to a molecule. Tau proteins with too many phosphate groups may form tangles, which can disrupt neuron function. This process is thought to be a factor in Alzheimer’s and other similar diseases.

MAAA, kidney transplant immune quiescence: The panel accepted 8156X for “transplantation medicine gene expression profiling.” Tests like this can help identify patients with a low probability of rejecting a kidney transplant. This code will be in the MAAA section. MAAAs use testing and algorithmic analysis of the tests (and possibly other patient information) to produce a score or probability.

Deletion? The May 2024 panel meeting will include more discussions that may affect the 2025 code set. In particular, these codes have been proposed for deletion because of low use:

• 86327 (Immunoelectrophoresis; crossed (2-dimensional assay))
• 86490 (Skin test; coccidioidomycosis)
• +88388 (Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); 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))

Tip: For insights into new test codes that will be included in Medicare’s Clinical Laboratory Fee Schedule (CLFS) for payment in 2025, join the public meeting virtually on June 25, 2024. The announcement is at www.federalregister.gov/d/2024-08005.

Know What’s New for PLA and MAAA

The January 2025 annual updates aren’t the only ones you need to know. CPT^® also releases quarterly PLA code updates and may provide MAAA codes throughout the year.

April 2024: The April 2024 PLA updates are already effective and include the addition of 11 codes (0439U-0449U) and deletion of two codes (0354U for PreTect HPV-Proofer’ 7 from GenePace Laboratories LLC and 0416U for GENETWORx UTI with ABR from RCA Laboratory Services LLC).

One other April update to note is revision of the proprietary name connected to 0407U (Nephrology (diabetic chronic kidney disease [CKD]), multiplex electrochemiluminescent immunoassay (ECLIA) of soluble tumor necrosis factor receptor 1 (sTNFR1), soluble tumor necrosis receptor 2 (sTNFR2), and kidney injury molecule 1 (KIM-1) combined with clinical data, plasma, algorithm reported as risk for progressive decline in kidney function). The new name, kidneyintelX. dkd™, replaces the previous one: IntelxDKD™. The test is from Renalytix Inc. and uses a plasma specimen to detect biomarkers listed in the code. The test includes an algorithmic analysis using test results and clinical factors to report a risk score for progressive kidney function decline.

July 2024: PLA updates effective July 1, 2024, include 26 new codes (0450U- 0475U) and two deleted codes (0204U for Afirma Xpression Atlas from Veracyte Inc. and 0353U for Xpert^® CT/NG from Cepheid^®).

As with the April changes, there are revisions to note. First, CPT^® revises the names associated with 0047U (Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score). The update replaces “Oncotype DX Genomic Prostate Score, Genomic Health Inc., Genomic Health Inc.” with “Genomic Prostate Score^® (GPS) Test, MDxHealth Inc., MDxHealth Inc.” The test, performed on a prostate biopsy sample, measures the activity of cancer-related genes in the tumor tissue

Second, CPT^® revises the notes under 0260U and 0264U, which have identical descriptors: Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping. The updated notes alert you to the addition of a third code with the same descriptor, 0454U. You choose among the codes based on the specific test provided. CPT^® AMA Appendix O, which lists MAAA and PLA codes, and the online PLA files provide the names of tests associated with codes. You can find the most recent PLA updates at www.ama-assn.org/practice-management/cpt/cpt-pla-codes.

There is also one new MAAA code effective July 1: 0020M (Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass). This code represents Epignostix CNS Tumor Methylation Classifier from Heidelberg Epignostix GmbH.

You can stay on top of MAAA updates by visiting www.ama-assn.org/practice-management/cpt/multianalyte-assays-algorithmic-analyses-codes.

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