CPT 2016 Code Changes

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1 CPT 2016 Code Changes Code Changes - Pathology and Lab New CPT 2016 New Codes Code Description Obstetric panel (includes HIV testing) This panel must include the following: Blood count, complete (CBC), and automated differential WBC count (85025 or and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901) BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis ABL1 (ABL proto-oncogene 1, nonreceptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence Advice CPT 2016 adds as an obstetric panel that includes testing for HIV. The existing obstetric panel code, (Obstetric panel, includes all the same tests, except that also includes an HIV test, (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 antigen or antigens, with HIV-1 and HIV-2 antibodies, single result). CPT 2016 adds in the Tier 1 molecular pathology section. Use this code for full gene sequence and duplication deletion analysis for BRCA1 and BRCA2. For more specifically targeted BRCA1 and/or BRCA2 genetic testing choose another appropriate code such as CPT 2016 adds in the Tier 1 molecular pathology section. Use this code for analyzing variants in the kinase domain of the ABL1 gene, also called BCR/ABL or ABL proto-oncogene 1 nonreceptor tyrosine kinase. CPT 2016 adds in the Tier 1 molecular pathology section. Use this code for analyzing the full gene sequence in the CCAAT/enhancer binding protein (C/EBP), alpha gene, also called CEBPA, CEBP, or C/EPB-alpha.

2 81219 CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18) KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variant(s) KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146) NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) CPT 2016 adds in the Tier 1 molecular pathology section. Use this code for analyzing known mutations in the exon 9 region of the calreticulin gene. You may also see the gene called CALR, calregulin, CRT, or endoplasmic reticulum resident protein 60, among others. CPT 2016 adds in the Tier 1 molecular pathology section. Use this code for analyzing targeted sequences in the v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog, or KIT gene. The analyzed sequences may include exons 8, 11, 13, 17, 18 or possibly other specific sequences. You may also see the gene called CD117, C-Kit, piebald trait protein, PBT, or mast/stem cell growth factor receptor Kit, among other names. Make sure to distinguish for KIT targeted sequence analysis from for gene analysis specifically involving the KIT gene D816 variant or variants. CPT 2016 adds in the Tier 1 molecular pathology section under parent code for analysis of other regions such as exons 8, 11, 13, 17, 18 of the same gene. Use for analyzing D816 variant or variants of the v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog, or KIT gene. CPT 2016 removes analysis for the KIT D816 variants from Tier 2 code CPT 2016 adds in the Tier 1 molecular pathology section under parent code for analysis of other variants of the KRAS gene such as codon 61 and 146. Use for analyzing KRAS variants found in locations other than exon 2, such as codons 61 or 146. CPT 2016 removes analysis for the KRAS variants in exon 3, such as codon 61, from Tier 2 code CPT 2016 adds in the Tier 1 molecular pathology section to describe the analysis of variants in exon 2, such as codons 12 and 13, and exon 3, such as codon 61 of the neuroblastoma RAS viral, v- ras, oncogene homolog, also called NRAS gene. CPT 2016 removes the descriptor for analysis of NRAS variants in exon 1 and 2 from Tier 2 code

3 81314 PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18) Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1 CPT 2016 adds in the Tier 1 molecular pathology section to describe a targeted sequence analysis of the platelet-derived growth factor receptor alpha polypeptide, or PDGFRA gene, possibly involving analysis of exons 12 and 18. CPT 2016 removes the descriptor for analysis of PDGFRA targeted sequence analysis for loci such as exons 12 and 18 from Tier 2 code CPT 2016 adds in the Genomic Sequencing Procedures and Other Molecular Multianalyte Assays section. Use this code for full genomic sequence analysis for least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1, for the evaluation of genetic susceptibility to Ashkenazi Jewish associated disorders. If the lab performs some but not all of these gene sequencing analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for ASPA Hereditary breast cancer-related CPT 2016 adds in the Genomic Sequencing disorders (eg, hereditary breast Procedures and Other Molecular Multianalyte Assays cancer, hereditary ovarian cancer, section. Use this code for full genomic sequence hereditary endometrial cancer); analysis for least 14 genes, including ATM, BRCA1, genomic sequence analysis panel, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, must include sequencing of at least 14 PALB2, PTEN, RAD51C, STK11, and TP53, for the genes, including ATM, BRCA1, BRCA2, evaluation of hereditary breast cancer disorders. If BRIP1, CDH1, MLH1, MSH2, MSH6, the lab performs some but not all of these gene NBN, PALB2, PTEN, RAD51C, STK11, sequencing analyses, you should not use this code, and TP53 but should instead report the appropriate code for an individual test, such as the appropriate code in the range for BRCA1 and BRCA Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11 CPT 2016 adds in the Genomic Sequencing Procedures and Other Molecular Multianalyte Assays section. Use this code for duplication and deletion analysis for least five genes, including BRCA1, BRCA2, MLH1, MSH2, and STK11, for the evaluation of hereditary breast cancer disorders. If the lab performs some but not all of these duplication and deletion analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for MSH2.

4 81434 Hereditary retinal disorders (eg, CPT 2016 adds in the Genomic Sequencing retinitis pigmentosa, Leber congenital Procedures and Other Molecular Multianalyte Assays amaurosis, cone-rod dystrophy), section. Use this code to evaluate hereditary retinal genomic sequence analysis panel, disorders using genomic sequence analysis for least must include sequencing of at least genes, including ABCA4, CNGA1, CRB1, EYS, genes, including ABCA4, CNGA1, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, CRB1, EYS, PDE6A, PDE6B, PRPF31, RP2, RPE65, RPGR, and USH2A. If the lab performs PRPH2, RDH12, RHO, RP1, RP2, some but not all of these genomic sequence RPE65, RPGR, and USH2A analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for ABCA4, PRPH2, and RP Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL Noonan spectrum disorders (eg, Noonan syndrome, cardio-faci- -cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1 CPT 2016 adds in the Genomic Sequencing Procedures and Other Molecular Multianalyte Assays section. Use this code to evaluate hereditary neuroendocrine tumor disorders using genomic sequence analysis for least six genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL. If the lab performs some but not all of these genomic sequence analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for SDHB and SDHC. CPT 2016 adds in the Genomic Sequencing Procedures and Other Molecular Multianalyte Assays section. Use this code to evaluate hereditary neuroendocrine tumor disorders using duplication and deletion analysis for least four genes, including SDHB, SDHC, SDHD, and VHL. If the lab performs some but not all of these genomic sequence analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for SDHC duplication and deletion analysis. CPT 2016 adds in the Genomic Sequencing Procedures and Other Molecular Multianalyte Assays section. Use this code to evaluate Noonan spectrum disorders using genomic sequence analysis for least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1. If the lab performs some but not all of these genomic sequence analyses, you should not use this code, but should instead report the appropriate code for an individual test, such as for BRAF.

5 81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score Coronary artery disease, mrna, gene expression profiling by real-time RT- PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to provide a disease activity score based on testing for 12 serum biomarker immunoassays. The specimen is serum. As with all MAAAs, the code describes both the lab test, in this case, 12 immunoassays, and an algorithm that uses the test results and possibly other patient data to calculate and report a patient grade, such as a disease activity score. CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate the risk of the patient developing CAD based on testing for real time reverse transcription polymerase chain reaction (RT-PCR), of 23 genes. The specimen is whole peripheral blood. As with all MAAAs, the code describes both the lab test, in this case, real time RT- PCR of 23 genes for mrna analysis, and an algorithm that uses the test results and possibly other patient data to calculate and report a patient risk score Oncology (colon), mrna, gene expression profiling by real-time RT- PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate the risk of colon cancer recurrence based on testing for real time reverse transcription polymerase chain reaction (RT-PCR), of 23 genes. The specimen is whole peripheral blood. As with all MAAAs, the code describes both the lab test, in this case, real time RT- PCR of 12 genes, and an algorithm that uses the test results and possibly other patient data to calculate and report a patient recurrence score. CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to screen patients for possible colon cancer based on testing for fecal hemoglobin and the presence or absence of 10 DNA markers that colorectal tumors might shed into the stool specimen used in the test. As with all MAAAs, the code describes both the lab test, in this case, a fecal hemoglobin immunoassay and real time amplification of 10 DNA markers, as well as the algorithm that uses the test results and possibly other patient data to calculate and report a patient risk score.

6 81535 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure) Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival Oncology (tumor of unknown origin), mrna, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate the susceptibility of gynecological tumors to a particular drug or drug combination. As with all MAAAs, the code describes both the lab test, in this case, tumor cell culture, cell morphology, and DAPI stain evaluation, as well as an algorithm that uses the test results and possibly other patient data to calculate and report a drug response score. CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate the susceptibility of gynecological tumors to a particular drug or drug combination following an initial test for a different drug or drug combination. As with all MAAAs, the code describes both the lab test, in this case, tumor cell culture, cell morphology, and DAPI stain evaluation, as well as an algorithm that uses the test results and possibly other patient data to calculate and report a drug response score. Because is an add on code, payers will not reimburse you if you report it without an appropriate primary code such as parent code CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate a serum specimen for eight proteins, including amyloid A using mass spectrometry. As with all MAAAs, the code describes both the lab test as well as an algorithm that uses the test results and possibly other patient data to calculate a risk score. In this case, the MAAA establishes a survival risk determination for lung cancer patients. CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to help identify the main cancer type and subtype for a tumor of unknown origin based on testing for real time RT polymerase chain reaction (RT-PCR), of 23 genes. As with all MAAAs, the code describes both the lab test, in this case, real time RT-PCR of 23 genes, and an algorithm that uses the test results and possibly other patient data to predict the main cancer type and subtype for the tumor specimen.

7 81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious) Cardiology (heart transplant), mrna, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score Immunofluorescence, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) Revised CPT 2016 Revised Codes Code Description BRAF (vb-raf murine sarcoma viral Raf proto-oncogene homolog B1, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600E variant(s) KRAS (v-ki-ras2 Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis, variants in codons 12 and 13; variants in exon 2 (eg, codons 12 and 13) CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test on thyroid fine needle aspiration, or FNA, specimens to evaluate gene expression in 142 genes and report the FNA specimen as either benign or suspicious for malignancy. The test helps eliminate unnecessary thyroid surgeries in patients with no thyroid malignancy. CPT 2016 adds to the section for multianalyte assays with algorithmic analyses, called MAAAs. Clinicians use this test to evaluate the risk of heart transplant rejection based on testing for real time polymerase chain reaction of 20 genes. The specimen is whole peripheral blood. As with all MAAAs, the code describes both the lab test, in this case, PCR of 20 genes, and an algorithm that uses the test results and possibly other patient data to calculate and report a patient rejection risk score. CPT 2016 revises parent code 88346, Immunofluorescence, per specimen; initial single antibody stain procedure, so that the code no longer specifies direct fluorescence studies, but also includes indirect fluorescence studies using a single antibody stain. CPT 2016 also deletes for indirect fluorescence studies, and adds to describe each additional antibody stain for additional fluorescence studies on the same specimen. Advice CPT 2016 revises to use the official name for the BRAF gene, B-Raf proto-oncogene, serine/threonine kinase, and to add melanoma as an example of conditions that a BRAF gene mutation might affect. The updated code also broadens the definition to specify any V600 variants, not just V600E. CPT 2016 revises to use the official name for the KRAS gene, Kirsten rat sarcoma viral oncogene homolog. The updated code also broadens the definition to specify any mutation on exon 2, with examples of codons 12 and 13. The revisions should not change how you use the code.

8 81355 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variants(s) (eg, -1639/ G>A, c c>t) CPT 2016 revises to update the example of common variants listed in the code, from -1639/3673 to G>A, c c>t. The revisions should not change how you use the code Molecular pathology procedure, CPT 2016 revises 81401, which represents all the Level 2 (eg, 2-10 SNPs, 1 technical work to complete just one specific molecular methylated variant, or 1 somatic test listed under the code. The revision involves adding variant [typically using some listed tests, such as DEK/NUP214 (t(6;9)) (e.g., nonsequencing target variant acute myeloid leukemia), translocation analysis, analysis], or detection of a qualitative, and quantitative, if performed and dynamic mutation disorder/triplet IGH@/BCL2 (t(14;18)) (e.g., follicular lymphoma), repeat) translocation analysis; single breakpoint (e.g., major ABL1 (ABL (cproto-abl oncogene 1, breakpoint region [MBR] or minor cluster region [mcr]), non-receptor tyrosine kinase) (eg, qualitative or quantitative (When both MBR and mcr acquired imatinib resistance), breakpoints are performed, use 81402). Each year, CPT T315I variant may add, delete, or revise some tests listed under each DEK/NUP214 (t(6;9)) (eg, acute Tier 2 test level. myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed IGH@/BCL2 (t(14;18)) (eg, follicular lymphoma), translocation analysis; single breakpoint (eg, major breakpoint region [MBR] or minor cluster region [mcr]), qualitative or quantitative (When both MBR and mcr breakpoints are performed, use 81402) Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T- cell receptor gene rearrangements, duplication/deletion variants of 1 exon, loss of heterozygosity [LOH], uniparental disomy [UPD]) KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), common variants (eg, D816V, D816Y, D816F) CPT 2016 revises 81402, which represents all the technical work to complete just one specific molecular test listed under the code. The revision involves deleting a listed test for KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., mastocytosis), common variants (e.g., D816V, D816Y, D816F). CPT 2016 adds a new Tier 1 molecular pathology code for this test: (KIT [v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog] [e.g., mastocytosis], gene analysis, D816 variant[s]). Each year, CPT may add, delete, or revise some tests listed under each Tier 2 test level.

9 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) ABL1 (c-abl oncogene 1, receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), variants in the kinase domain CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), full gene sequence KRAS (v-ki-ras2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma), gene analysis, variant(s) in exon 3 (eg, codon 61) 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) KIT (C-kit) (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, GIST, acute myeloid leukemia, melanoma), targeted gene analysis (eg, exons 8, 11, 13, 17, 18) NRAS (neuroblastoma RAS viral oncogene homolog) (eg, colorectal carcinoma), exon 1 and exon 2 sequences PDGFRA (platelet-derived growth factor receptor alpha polypeptide) (eg, gastrointestinal stromal tumor), targeted sequence analysis (eg, exons 12, 18) CPT 2016 revises 81403, which represents all the technical work to complete just one specific molecular test listed under the code. The revision involves deleting three tests that CPT 2016 then adds as new Tier 1 molecular pathology codes. The deleted tests are ABL1 (c-abl oncogene 1, receptor tyrosine kinase) (e.g., acquired imatinib tyrosine kinase inhibitor resistance), variants in the kinase domain, which becomes new code 81170; CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (e.g., acute myeloid leukemia), full gene sequence, which becomes new code 81218; and KRAS (v- Ki-ras2 Kirsten rat sarcoma viral oncogene) (e.g., carcinoma), gene analysis, variant(s) in exon 3 (e.g., codon 61) M, which becomes new code Each year, CPT may add, delete, or revise some tests listed under each Tier 2 test level. CPT 2016 revises 81404, which represents all the technical work to complete just one specific molecular test listed under the code. The revision involves deleting two tests that CPT 2016 then adds as new Tier 1 molecular pathology codes. The deleted tests are KIT (Ckit) (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., GIST, acute myeloid leukemia, melanoma), targeted gene analysis (e.g., exons 8, 11, 13, 17, 18) L, which becomes new code 81272; and NRAS (neuroblastoma RAS viral oncogene homolog) (e.g., colorectal carcinoma), exon 1 and exon 2 sequences PDGFRA (platelet-derived growth factor receptor alpha polypeptide) (e.g., gastrointestinal stromal tumor), targeted sequence analysis (e.g., exons 12, 18) P, which becomes new code Each year, CPT may add, delete, or revise some tests listed under each Tier 2 test level.

10 81405 Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of exons, regionally targeted cytogenomic array analysis) KRAS (v-ki-ras2 Kirsten rat sarcoma viral oncogene homolog) (eg, Noonan syndrome), full gene sequence Molecular pathology procedure, Level 7 (eg, analysis of exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of exons, cytogenomic array analysis for neoplasia) BRAF (vb-raf murine sarcoma viral Raf proto-oncogene homolog B1, serine/threonine kinase) (eg, Noonan syndrome), full gene sequence PCSK9 (proprotein convertase subtilisin/kexin type 9) (eg, familial hypercholesterolemia), full gene sequence Hereditary colon cancer syndromesdisorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysissequencing of at least 710 genes, including APC, BMPR1A, CHEK2CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and PMS2STK11 CPT 2016 revises 81405, which represents all the technical work to complete just one specific molecular test listed under the code. The revision involves updating the name for a listed test for KRAS full sequence analysis from v-ki-ras2 Kirsten rat sarcoma viral oncogene homolog to Kirsten rat sarcoma viral oncogene homolog, but the test remains under Each year, CPT may add, delete, or revise some tests listed under each Tier 2 test level. CPT 2016 revises 81406, which represents all the technical work to complete just one specific molecular test listed under the code. The revision involves adding a listed test and updating the name of another test. CPT 2016 adds PCSK9 (proprotein convertase subtilisin/kexin type 9) (e.g., familial hypercholesterolemia), full gene sequence, and corrects the name of the BRAF test from BRAF (v-raf murine sarcoma viral oncogene homolog B1) to (B-Raf proto-oncogene homolog B1) (e.g., Noonan syndrome), full gene sequence, which doesn t change how you report the test. Each year, CPT may add, delete, or revise some tests listed under each Tier 2 test level. CPT 2016 revises for hereditary colon cancer disorders by broadening the code from testing for Lynch Syndrome and familial adenomatosis polyposis to also include PTEN hamartoma syndrome, Cowden syndrome. The code definitions changes from a panel including analysis of at least seven genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2, to a panel including analysis of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11

11 81436 duplication/deletion gene analysis panel, must include analysis of at least 85 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2SMAD4, and MUTYHSTK Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, and RNA analysis when performed, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA analysis, and RNA analysis when performed, 5-50Â Â genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mrna expression levels, if performed CPT 2016 revises for hereditary colon cancer disorders by broadening the code from testing for Lynch Syndrome and familial adenomatosis polyposis to also include PTEN hamartoma syndrome, Cowden syndrome. The code definitions changes from a panel including duplication/deletion analysis of at least eight genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYH, to a panel including duplication deletion analysis of at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11. CPT 2016 revises targeted genomic sequence analysis for solid organ tumors to include RNA analysis, if performed. In 2015, the code definition specified DNA analysis. The addition of RNA to the code is a clarification, and should not change the way you use this code. CPT 2016 revises targeted genomic sequence analysis for solid organ tumors to include RNA analysis, if performed. In 2015, the code definition specified DNA analysis. The addition of RNA to the code is a clarification, and should not change the way you use this code.

12 81455 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed Column chromatography/, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, orgc/ms, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen; quantitative, single stationary and mobile phase Mass spectrometry and tandem mass spectrometry (eg, MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen; quantitative, each specimen CPT 2016 revises targeted genomic sequence analysis for solid organ or hematolymphoid neoplasms with a minor wording change from DNA and RNA analysis to DNA analysis, and RNA analysis. The revision does not alter the meaning of the code, and should not change the way you use the code. CPT 2016 revises and deletes all other codes in the range to so that, beginning in 2016, you should report for any unlisted qualitative or quantitative non-drug test using column chromatography and mass spectrometry, if performed. Types of testing include gas chromatography, called GC, liquid chromatography, called LC, high performance liquid chromatography, called HPLC, mass spectrometry, called MS, and tandem mass spectrometry, called MS-MS. The test may also involve combination methods such as LC/MS, LC/MS-MS, GC/MS, GC/MS-MS, or HPLC/MS. CPT 2016 revises to remove the quantitative restriction, and deletes for qualitative testing. That means that beginning in 2016, you should report for any unlisted qualitative or quantitative non-drug test using mass spectrometry. Types of testing include mass spectrometry, called MS, and tandem mass spectrometry, called MS/MS), which also includes methods such as matrix assisted laser desorption/ionization (MALDI), mass spectrometry time-of-flight (MS-TOF), or quadrupole timeof-flight (QTOF) Hepatitis A antibody (HAAb); total CPT 2016 revises code to remove the word total from the descriptor, and to remove the semicolon so that it is no longer a parent code for You should continue to report for hepatitis A antibody (HAAb), except for the IgM class, which you should report using Hepatitis A antibody (HAAb), IgM antibody; IgM antibody CPT 2016 revises code so that it is no longer indented under parent code You should continue to use as you always have to report hepatitis A IgM antibody testing.

13 87301 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay technique[eia], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; adenovirus enteric types 40/41 CPT 2016 revises the common part of the code descriptor for 87301, which is a parent code for to 87430, meaning that the definition changes for all codes in that range. The revision simply adds clarifying language to give examples of immunoassay techniques, such as enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), or immunochemiluminometric assay (IMCA). You should not change how you use the codes p>aspergillus CPT 2016 revises as part of a change to all Chlamydia trachomatis CPT 2016 revises as part of a change to all Clostridium difficile toxin(s) CPT 2016 revises as part of a change to all

14 87327 Cryptococcus neoformans CPT 2016 revises as part of a change to all cryptosporidium CPT 2016 revises as part of a change to all giardia CPT 2016 revises as part of a change to all cytomegalovirus CPT 2016 revises as part of a change to all

15 87335 Escherichia coli 0157 CPT 2016 revises as part of a change to all Entamoeba histolytica dispar group CPT 2016 revises as part of a change to all Entamoeba histolytica group CPT 2016 revises as part of a change to all Helicobacter pylori, stool CPT 2016 revises as part of a change to all

16 87339 Helicobacter pylori CPT 2016 revises as part of a change to all hepatitis B surface antigen (HBsAg) hepatitis B surface antigen (HBsAg) neutralization CPT 2016 revises as part of a change to all CPT 2016 revises as part of a change to all hepatitis Be antigen (HBeAg) CPT 2016 revises as part of a change to all

17 87380 hepatitis, delta agent CPT 2016 revises as part of a change to all Histoplasma capsulatum CPT 2016 revises as part of a change to all HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result CPT 2016 revises as part of a change to all HIV-1 CPT 2016 revises as part of a change to all

18 87391 HIV-2 CPT 2016 revises as part of a change to all Influenza, A or B, each CPT 2016 revises as part of a change to all respiratory syncytial virus CPT 2016 revises as part of a change to all rotavirus CPT 2016 revises as part of a change to all

19 87427 Shiga-like toxin CPT 2016 revises as part of a change to all Streptococcus, group A CPT 2016 revises as part of a change to all Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay technique[eia], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; multiple -step method, not otherwise specified, each organism single step method, not otherwise specified, each organism CPT 2016 revises as part of a change to all codes in the range to The revision alters the common part of the code descriptor for 87449, which is a parent code for and 87451, meaning that the CPT 2016 revises as part of a change to all codes in the range to The revision alters the common part of the code descriptor for 87449, which is a parent code for and 87451, meaning that the

20 87451 multiple step method, polyvalent for multiple organisms, each polyvalent antiserum influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure) Immunofluorescent studyimmunofluorescence, each antibodyper specimen; direct methodinitial single antibody stain procedure Deleted CPT 2016 revises as part of a change to all codes in the range to The revision alters the common part of the code descriptor for 87449, which is a parent code for and 87451, meaning that the CPT 2016 revises to clarify that the code includes multiplex reverse transcription, if performed. In 2015, the code definition specified multiplex reverse transcription as part of the procedure, but not every test of this type involves a reverse transcription step. The code revision in 2016 specifies that the multiplex reverse transcription is optional, so you can accurately use the code with or without that step. CPT 2016 revises to clarify that the code includes multiplex reverse transcription, if performed. In 2015, the code definition specified multiplex reverse transcription as part of the procedure, but not every test of this type involves a reverse transcription step. The code revision in 2016 specifies that the multiplex reverse transcription is optional, so you can accurately use the code with or without that step. CPT 2016 revises parent code 88346, Immunofluorescence, per specimen; initial single antibody stain procedure, so that the code no longer specifies direct fluorescence studies, but also includes indirect fluorescence studies using a single antibody stain. CPT 2016 also deletes for indirect fluorescence studies, and adds to describe each additional antibody stain for additional fluorescence studies on the same specimen. CPT 2016 Deleted Codes Code Description Crosswalk Code Advice

21 82486 Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not elsewhere specified Chromatography, qualitative; paper, 1- dimensional, analyte not elsewhere specified (82486 has CPT 2016 deletes 82486, which describes been deleted. qualitative column chromatography for an For a qualitative analyte not specified in any other code. column Examples include gas liquid chromatography, chromatography called GLC, or high performance liquid procedure, use chromatography, called HPLC. This deletion is the appropriate part of an overall revision of how you should specific analyte report column chromatography and mass code, if spectrometry, or MS, procedures for unspecified available, or analytes. CPT 2016 deletes all codes in the 82542) range to 83789, except for revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, but adds the distinction that you can use the codes only for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in (82487, CPT 2016 deletes 82487, which describes have been one-dimensional qualitative paper deleted. For a chromatography for an analyte not specified in paper any other code. The code describes an older chromatography test method that labs rarely perform. The procedure, use deletion is part of an overall revision of the appropriate how you should report chromatography and specific analyte mass spectrometry, or MS, procedures for code, if unspecified analytes. CPT 2016 deletes all available, or codes in the range to 83789, except for 84999) revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, but adds the distinction that you can use the codes only for unspecified nondrug analytes. Because the revised chromatography code does not include paper chromatography, you should not crosswalk to beginning in 2016, but must instead use an unlisted procedure code such as in the rare case that your lab performs this procedure.

22 82488 Chromatography, qualitative; paper, 2- dimensional, analyte not elsewhere specified Chromatography, qualitative; thin layer, analyte not elsewhere specified (82487, CPT 2016 deletes 82488, which describes have been two-dimensional qualitative paper deleted. For a chromatography for an analyte not specified in paper any other code. The code describes an older chromatography test method that labs rarely perform. The procedure, use deletion is part of an overall revision of the appropriate how you should report chromatography and specific analyte mass spectrometry, or MS, procedures for code, if unspecified analytes. CPT 2016 deletes all available, or codes in the range to 83789, except for 84999) revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, but adds the distinction that you can use the codes only for unspecified nondrug analytes. Because the revised chromatography code does not include paper chromatography, you should not crosswalk to beginning in 2016, but must instead use an unlisted procedure code such as in the rare case that your lab performs this procedure. (82489 has CPT 2016 deletes 82489, which describes been deleted. qualitative thin layer chromatography, called For a thin layer TLC, for an analyte not specified in any other chromatography code. The deletion is part of an overall procedure, use revision of how you should report the appropriate chromatography and mass spectrometry, or MS, specific analyte procedures for unspecified analytes. CPT code, if 2016 deletes all codes in the range to available, or 83789, except for revised codes and 84999) The revised codes encompass all column chromatography and MS procedures for unspecified analytes, but adds the distinction that you can use the codes only for unspecified nondrug analytes. Because the revised chromatography code does not include TLC, you should not crosswalk to beginning in 2016, but must instead use an unlisted procedure code such as if your lab performs this procedure.

23 82491 Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes, single stationary and mobile phase (82491 has been deleted. For a quantitative column chromatography procedure, use the appropriate specific analyte code, if available, or 82542) CPT 2016 deletes 82491, which describes quantitative column chromatography for a single analyte not specified in any other code. Examples include gas liquid chromatography, called GLC, or high performance liquid chromatography, called HPLC. This deletion is part of an overall revision of how you should report column chromatography and mass spectrometry, or MS, procedures for unspecified analytes. CPT 2016 deletes all codes in the range to 83789, except for revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, but adds the distinction that you can use the codes only for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in (82492 has CPT 2016 deletes 82492, which describes been deleted. quantitative column chromatography for For a multiple analytes not specified in any other quantitative code. Examples include gas liquid column chromatography, called GLC, or high chromatography performance liquid chromatography, called procedure that HPLC. This deletion is part of an overall revision detects more of how you should report column than one chromatography and mass spectrometry, or MS, analyte, use a procedures for unspecified analytes. CPT single specific 2016 deletes all codes in the range to code that 83789, except for revised codes and represents all of The revised codes encompass all the analytes, if column chromatography and MS procedures for available, or unspecified analytes, but adds the distinction one unit of that you can use the codes only for unspecified for all of nondrug analytes. Crosswalk your tests the analytes) for nondrug analytes to beginning in 2016.

24 82541 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; qualitative, single stationary and mobile phase Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, single analyte, quantitative, single stationary and mobile phase (82541 has CPT 2016 deletes 82541, which describes been deleted. qualitative column chromatography and mass For a spectrometry, called MS, for an analyte not quantitative specified in any other code. Examples include chromatography gas chromatography with MS, called GC/MS, or procedure with high performance liquid chromatography with mass MS, called HPLC/MS. This deletion is part of an spectrometry overall revision of how you should report that only column chromatography and mass detects a single spectrometry procedures for unspecified specific analyte, analytes. CPT 2016 deletes all codes in the use the range to 83789, except for revised codes appropriate and The revised codes specific analyte encompass all column chromatography and MS code, if procedures for unspecified analytes, and makes applicable, or the distinction that you can use the codes only 82542) for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in (82543 has CPT 2016 deletes 82543, which describes been deleted. quantitative column chromatography and mass For a spectrometry, called MS, for a single analyte quantitative not specified in any other code. Examples chromatography include gas chromatography with MS, called procedure with GC/MS, or high performance liquid mass chromatography with MS, called HPLC/MS. This spectrometry deletion is part of an overall revision of how you that only should report column chromatography and detects a single mass spectrometry procedures for unspecified specific analyte, analytes. CPT 2016 deletes all codes in the use the range to 83789, except for revised codes appropriate and The revised codes specific analyte encompass all column chromatography and MS code, if procedures for unspecified analytes, and makes available, or the distinction that you can use the codes only 82542) for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in 2016.

25 82544 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, multiple analytes, quantitative, single stationary and mobile phase Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; qualitative, each specimen (82544 has been deleted. For a quantitative chromatography procedure with mass spectrometry that detects more than one analyte, use a single specific code that represents all of the analytes, if available, or one unit of for all of the analytes) (83788 has been deleted. For a qualitative mass spectrometry or tandem mass spectrometry procedure, use the specific analyte code, if available, or 83789) CPT 2016 deletes 82544, which describes quantitative column chromatography and mass spectrometry, called MS, for multiple analytes not specified in any other code. Examples include gas chromatography with MS, called GC/MS, or high performance liquid chromatography with MS, called HPLC/MS. This deletion is part of an overall revision of how you should report column chromatography and mass spectrometry procedures for unspecified analytes. CPT 2016 deletes all codes in the range to 83789, except for revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, and makes the distinction that you can use the codes only for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in CPT 2016 deletes 83788, which describes qualitative mass spectrometry, called MS, or tandem mass spectrometry, called MS/MS, for an analyte not specified in any other code. This deletion is part of an overall revision of how you should report column chromatography and mass spectrometry procedures for unspecified analytes. CPT 2016 deletes all codes in the range to 83789, except for revised codes and The revised codes encompass all column chromatography and MS procedures for unspecified analytes, and makes the distinction that you can use the codes only for unspecified nondrug analytes. Crosswalk your tests for nondrug analytes to beginning in 2016.