Pathology/Lab Coding Alert

Question: Our molecular lab performs a genomic sequence analysis panel for long QT syndrome that includes the following: AKAP9, ANK2, CACNA1C, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, SCN4B, and SCN5A. Should we bill this with new-code 1413 for cardiac ion channelopathies or should we bill each gene with a Tier 2 molecular pathology code based on the number of exons?

Nebraska Subscriber

Answer: No, you should not bill 81413 (Cardiac ion channelopathies [eg, Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia]; genomic sequence analysis panel, must include sequencing of at least 10 genes, including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A) for the panel you describe.

Here's why: To report 81413, your panel must include "at least" the 10 genes listed in the code. Your panel does not include CASQ2 or RYR2.

Not so fast: Although that does mean that you'll need to code the genes individually, you can't necessarily use Tier 2 codes for each gene. That's because not every gene you mention is listed in a Tier 2 code. Although the Tier 2 codes represent increasing levels of resources and work, such as the number of exons interrogated, you should not use a Tier 2 code for a gene that is not specifically listed under that Tier 2 code.

Do this: For each gene that is listed under a Tier 2 code, report that code as follows (gene name underlined for clarity):

• 81403 (Molecular pathology procedure, Level 4 [eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons] ... KCNJ2 [potassium inwardly-rectifying channel, subfamily J, member 2] [eg, Andersen-Tawil syndrome], full gene sequence ...)
• 81404 (Molecular pathology procedure, Level 5 [eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis], ... CAV3 [caveolin 3] [eg, CAV3-related distal myopathy, limb-girdle muscular dystrophy type 1C], full gene sequence...)
• 2 units of 81406 (Molecular pathology procedure, Level 7 [eg, analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia],... KCNH2 [potassium voltage-gated channel, subfamily H (eag-related), member 2] [eg, short QT syndrome, long QT syndrome], full gene sequence, KCNQ1 [potassium voltage-gated channel, KQT-like subfamily, member 1] [eg, short QT syndrome, long QT syndrome], full gene sequence...)
• 81407 (Molecular pathology procedure, Level 8 [eg, analysis of 26-50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform] ... SCN5A [sodium channel, voltage-gated, type V, alpha subunit) (eg, familial dilated cardiomyopathy], full gene sequence...)

For the remaining genes in your panel that aren't listed under a Tier 2 code, you should report 81479 (Unlisted molecular pathology procedure). These genes are AKAP9, ANK2, CACNA1C, KCNE1, KCNE2, and SCN4B.

You'll need to submit supporting documentation to describe the work involved in analyzing these additional genes and suggest a code equivalency, such as Tier 2 codes for each unlisted gene based on the number of exons, or an entirely different gene sequence analysis with similar number of genes and level of work.