Pathology/Lab Coding Alert
Get Details For Accurate BRCA1 Coding
Question: I’m doing billing for a lab that reported performing a “BRCA1 molecular test.” What is the correct procedure code for this test? Alabama Subscriber Answer: You’ll need to get more specific information from the lab, because there are many procedures that include molecular testing for the BRCA1 gene. Tier 1: For instance, CPT® provides a unique code in the Tier 1 Molecular Pathology section that describes a full gene sequence analysis for the BRCA1 gene -- 81165 (BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis) -- as well as other codes that include BRCA1 evaluation. GSP: In the CPT® section for Genomic Sequencing Procedures and Other Molecular Multianalyte Assays (GSP), you’ll find BRCA1 gene analysis included in a broader panel code: 81432 (Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); 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). MAAA: The CPT® section for Multianalyte Assays with Algorithmic Analyses (MAAA procedures) provides codes that include molecular test of many genes, which may include BRCA1, such as 81519 (Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score). PLA: Certain codes in the Proprietary Laboratory Analyses (PLA) CPT® section include molecular testing for BRCA1, such as 0138U (BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) mRNA sequence analysis (List separately in addition to code for primary procedure)). Bottom line: The lab should document what test they’re performing, including the appropriate CPT® code, if possible.
Pathology/Lab Coding Alert
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