How To Use CPT Code 81445

CPT 81445 describes the targeted genomic sequence analysis panel for solid organ neoplasms, analyzing 5-50 genes for sequence variants and copy number variants or rearrangements. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81445?

CPT 81445 is used to describe a targeted genomic sequence analysis panel for solid organ neoplasms. This panel analyzes 5-50 genes to identify sequence variants and copy number variants or rearrangements. The analysis is performed on DNA and possibly RNA extracted from a patient’s tumor specimen. The results of this analysis help clinicians evaluate the genetic mutations and expression patterns that may be involved in the development and progression of solid tissue tumors, aiding in the determination of appropriate treatment.

2. Official Description

The official description of CPT code 81445 is: ‘Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis.’

3. Procedure

1. The lab analyst receives a patient’s tumor specimen for analysis.
2. The specimen is processed to extract DNA and possibly RNA.
3. The lab analyst amplifies the target DNA and possibly RNA using techniques like polymerase chain reaction (PCR) or reverse transcription PCR (RT-PCR).
4. The amplified DNA and possibly RNA are subjected to next generation sequencing (NGS) to determine the order of nucleotides in the genes of interest.
5. Bioinformatics tools are used to interpret the sequencing results and identify sequence variants, copy number variants, and rearrangements.
6. The findings are compared to known genetic changes associated with solid organ neoplasms to provide insights into the patient’s condition.

4. Qualifying circumstances

CPT 81445 is used for patients with solid organ neoplasms who require genomic sequence analysis of 5-50 genes. The analysis helps identify sequence variants and copy number variants or rearrangements that may be relevant to the patient’s condition. The test is performed on DNA and possibly RNA extracted from the patient’s tumor specimen. It is important to note that this code specifically applies to the analysis of solid organ neoplasms and not other types of tumors or genetic conditions.

5. When to use CPT code 81445

CPT code 81445 should be used when a targeted genomic sequence analysis panel is performed on a patient’s tumor specimen to analyze 5-50 genes for sequence variants and copy number variants or rearrangements. This code is appropriate for solid organ neoplasms and helps clinicians evaluate the genetic changes associated with these types of tumors. It is important to ensure that the analysis includes the specified number of genes and covers the necessary variants and variants of interest.

6. Documentation requirements

To support a claim for CPT code 81445, the following documentation is required:

• Identification of the patient’s solid organ neoplasm
• Details of the targeted genomic sequence analysis panel, including the specific genes analyzed
• Documentation of the DNA analysis or combined DNA and RNA analysis performed
• Results of the analysis, including any identified sequence variants, copy number variants, or rearrangements
• Interpretation of the findings in relation to known genetic changes associated with solid organ neoplasms
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 81445, ensure that the analysis is performed on a patient’s tumor specimen and includes the analysis of 5-50 genes for sequence variants and copy number variants or rearrangements. It is important to distinguish between CPT code 81445, which includes DNA analysis or combined DNA and RNA analysis, and CPT code 81449, which specifically refers to RNA analysis of the same genes. Additionally, if the analysis includes more than 50 genes, CPT code 81455 should be used instead of 81445. It is also important to consider any additional codes that may be necessary for specimen preparation steps before the molecular analysis.

8. Historical information

CPT code 81445 was added to the Current Procedural Terminology system on January 1, 2015. Since then, there have been two code changes. On January 1, 2016, the code was updated to include DNA analysis of 5-50 genes. On January 1, 2023, the code was further revised to include combined DNA and RNA analysis when performed.

9. Examples

1. A lab analyst performs a targeted genomic sequence analysis panel on a patient’s tumor specimen, analyzing 10 genes for sequence variants and copy number variants or rearrangements associated with solid organ neoplasms.
2. Using next generation sequencing, the lab analyst analyzes 30 genes in a patient’s tumor specimen to identify sequence variants and copy number variants or rearrangements relevant to the development and progression of solid tissue tumors.
3. For a patient with a suspected solid organ neoplasm, the lab analyst performs a targeted genomic sequence analysis panel on their tumor specimen, analyzing 50 genes for sequence variants and copy number variants or rearrangements.