How To Use CPT Code 81450

CPT 81450 describes the targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorders. 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 81450?

CPT 81450 can be used to describe the targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorders. This code is used when a lab analyst performs a genomic sequence analysis panel to evaluate a patient specimen, such as blood or bone marrow, for DNA and possibly RNA alterations in five to 50 genes known to impact blood or lymph disorders or cancers.

2. Official Description

The official description of CPT code 81450 is: ‘Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis.’

3. Procedure

1. The lab analyst processes the patient specimen, such as blood or bone marrow, to extract nucleic acids.
2. The lab analyst amplifies the target DNA and possibly RNA using procedures like polymerase chain reaction (PCR) or reverse transcription PCR (RT-PCR).
3. The lab analyst evaluates the nucleic acids using next generation sequencing (NGS) to determine the order of DNA or RNA nucleotides in the genes of interest.
4. The lab analyst uses bioinformatics to interpret the results and identify sequence variants, copy number variants, rearrangements, or isoform expression or mRNA expression levels, if performed.

4. Qualifying circumstances

Patients eligible for CPT 81450 are those with hematolymphoid neoplasms or disorders. The test helps to characterize the genetic mutation and expression involved in the disease process, aiding clinicians in determining appropriate treatment. The test analyzes DNA and possibly RNA alterations in five to 50 genes known to impact blood or lymph disorders or cancers.

5. When to use CPT code 81450

CPT code 81450 should be used when a lab analyst performs a targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorders, evaluating DNA and possibly RNA alterations in five to 50 genes. This code is appropriate when the analysis includes interrogation for sequence variants, copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed.

6. Documentation requirements

To support a claim for CPT 81450, the lab analyst must document the following information:

• Patient specimen used for analysis (e.g., blood, bone marrow)
• Genes included in the analysis (e.g., BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS)
• Procedure used for DNA and possibly RNA analysis (e.g., PCR, RT-PCR)
• Start and end time of the analysis
• Results of the analysis, including sequence variants, copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81450, ensure that the analysis includes DNA analysis or combined DNA and RNA analysis of five to 50 genes. It is important to distinguish between CPT 81450 and CPT 81451, which describes RNA analysis only. Do not report additional codes for tests that evaluate a single gene included in the CPT 81450 panel. If the analysis includes more than 50 genes, use CPT 81455 instead. Some payers may also separately reimburse for specimen collection.

8. Historical information

CPT 81450 was added to the Current Procedural Terminology system on January 1, 2015. There have been updates to the code since its addition, including changes to the description and the addition of RNA analysis when performed.

9. Examples

1. A lab analyst performs a targeted genomic sequence analysis panel for a patient with suspected lymphoma, evaluating DNA alterations in genes such as BRAF, CEBPA, and FLT3.
2. Using a patient’s bone marrow specimen, a lab analyst analyzes DNA and RNA alterations in genes like IDH1, IDH2, and NPM1 to help diagnose and characterize a hematolymphoid disorder.
3. A lab analyst performs a targeted genomic sequence analysis panel on a blood sample from a patient with leukemia, evaluating DNA and RNA alterations in genes such as NOTCH1, NRAS, and KIT.
4. Using next generation sequencing, a lab analyst analyzes DNA and RNA alterations in genes like DNMT3A, EZH2, and MLL to assess the genetic profile of a patient with myelodysplastic syndrome.
5. A lab analyst performs a targeted genomic sequence analysis panel on a patient’s blood specimen, evaluating DNA and RNA alterations in genes such as JAK2, KRAS, and KIT to aid in the diagnosis and treatment of a hematolymphoid neoplasm.