Health Information Management

Tip: Note new guidelines for molecular pathology codes

APCs Insider, March 2, 2012

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Molecular pathology procedures are laboratory procedures that analyze nucleic acid to detect variations in genes that may indicate constitutional disorders or somatic (e.g., neoplasm) conditions. These tests may also be used to test for histocompatibility antigens.

The codes are based on the analyte or the gene-to-gene variant and not on the technology or the methodology used to determine the result.

The CPT® Manual uses the Human Genome Organization-approved gene names. The code descriptors also include proteins or diseases associated with the genes. For example, code 81228 denotes cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (e.g. Bacterial Artificial Chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis.

When an abbreviation denotes a gene name, the abbreviation appears first in the code description, followed by the complete gene name in parentheses. One example is code 81240, F2 (prothrombin, coagulation factor II) (e.g., hereditary hypercoagulability) gene analysis, 20210G>A variant.

Molecular pathology guidelines state that coders should separately report any procedures performed prior to cell lysis, such as microdissection.

Some tests require a physician or other qualified healthcare professional to interpret results. When providers only perform the interpretation, coders should append modifier -26 (professional component) to the specific pathology code.

The CPT® Manual also includes an extensive list of definitions for molecular pathology that can assist coders. Coders will find additional instructional parenthetical notes and cross-references throughout the section.

The tip is adapted from “Note major updates to pathology and laboratory section” in the February issue of Briefings on APCs.

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