How To Use CPT Code 81520

CPT 81520 describes the process of mRNA gene expression profiling for breast cancer using hybrid capture of 58 genes. 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 81520?

CPT 81520 is used to report the mRNA gene expression profiling for breast cancer. This test involves the analysis of 58 genes using hybrid capture techniques. The results of the test are used to calculate a recurrence risk score, which provides information about the likelihood of distant-site recurrence of breast cancer.

2. Official Description

The official description of CPT code 81520 is: ‘Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score.’

3. Procedure

1. The lab analyst performs mRNA gene expression profiling for breast cancer using formalin-fixed paraffin-embedded tissue from a breast tumor.
2. The lab analyst uses hybrid capture techniques to analyze 58 genes, including 50 content genes and 8 housekeeping genes.
3. The lab analyst carries out an algorithmic analysis using patient data and the lab test results to calculate a recurrence risk score.
4. The recurrence risk score provides information about the likelihood of distant-site recurrence of breast cancer.

4. Qualifying circumstances

CPT 81520 is used when mRNA gene expression profiling is performed for breast cancer using hybrid capture techniques. The test is typically ordered by clinicians to assess the likelihood of breast cancer recurrence, which can help inform treatment decisions and follow-up protocols. The test is performed on formalin-fixed paraffin-embedded tissue from a breast tumor.

5. When to use CPT code 81520

CPT code 81520 should be used when mRNA gene expression profiling is performed for breast cancer using hybrid capture techniques. It is appropriate to use this code when the test is ordered to assess the likelihood of breast cancer recurrence. However, it should not be used for testing related to other conditions or diseases.

6. Documentation requirements

To support a claim for CPT 81520, the following documentation is required:

• Documentation of the breast tissue specimen used for the test
• Details of the hybrid capture techniques used for mRNA gene expression profiling
• Information about the algorithmic analysis performed and the recurrence risk score calculated
• Relevant patient data used in the analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81520, ensure that the test is performed using hybrid capture techniques for mRNA gene expression profiling in breast cancer. It is important to follow the specific guidelines for reporting this code and to accurately document the necessary information. CPT code 81520 should not be reported with other codes unless there are specific circumstances that warrant additional reporting. It is also important to note that the test includes all necessary lab services, so separate reporting of technical lab tests is not required.

8. Historical information

CPT 81520 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a history of breast cancer undergoes mRNA gene expression profiling using hybrid capture techniques to assess the likelihood of recurrence.
2. A clinician orders mRNA gene expression profiling for a newly diagnosed breast cancer patient to guide treatment decisions.
3. A patient with a high risk of breast cancer recurrence undergoes mRNA gene expression profiling to determine the appropriate follow-up protocols.
4. A breast cancer patient with a low recurrence risk score undergoes mRNA gene expression profiling to provide reassurance and inform treatment decisions.
5. A clinician orders mRNA gene expression profiling for a breast cancer patient with ambiguous pathology results to gain further insights into the disease.
6. A patient with a family history of breast cancer undergoes mRNA gene expression profiling to assess their own risk of developing the disease.
7. A clinician uses mRNA gene expression profiling to monitor the response to treatment in a breast cancer patient.
8. A patient with a previous breast cancer diagnosis undergoes mRNA gene expression profiling to guide decisions about adjuvant therapy.
9. A clinician orders mRNA gene expression profiling for a breast cancer patient with metastatic disease to assess the likelihood of distant-site recurrence.
10. A patient with a breast tumor undergoes mRNA gene expression profiling to determine the appropriate surgical approach.