How To Use CPT Code 81521

CPT 81521 describes the analysis of gene expression in breast cancer using mRNA microarray technology. 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 81521?

CPT 81521 can be used to report the analysis of gene expression in breast cancer using mRNA microarray technology. This code is specifically used for the analysis of 70 content genes and 465 housekeeping genes in fresh frozen or formalin-fixed paraffin-embedded tissue samples. The results of this analysis are reported as an index related to the risk of distant metastasis.

2. Official Description

The official description of CPT code 81521 is: ‘Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis.’

3. Procedure

1. The lab analyst performs the technical lab tests to analyze 70 genes using mRNA microarray analysis.
2. The lab analyst uses formalin-fixed paraffin-embedded tissue from a breast tumor to perform the analysis.
3. A microarray, or gene “chip,” is used to hybridize the specimen mRNA with DNA spots on a solid surface, providing a profile of gene expression in the tissue sample.
4. The lab analyst inputs the test results and specific patient data into a computer program to analyze the data using a specific algorithm.
5. The algorithmic analysis produces a breast cancer recurrence score, which is reported as an index related to the risk of distant metastasis.

4. Qualifying circumstances

CPT 81521 is used for patients with breast cancer who require an assessment of the likelihood of distant metastasis. This test is typically ordered for patients with early-stage breast cancer to help inform treatment decisions, such as the need for chemotherapy. The test is performed on fresh frozen or formalin-fixed paraffin-embedded tissue samples from a breast tumor.

5. When to use CPT code 81521

CPT code 81521 should be used when analyzing gene expression in breast cancer using mRNA microarray technology. It is appropriate to use this code when assessing the risk of distant metastasis in patients with early-stage breast cancer. This code should not be reported in conjunction with CPT code 81523 for the same specimen.

6. Documentation requirements

To support a claim for CPT code 81521, the following documentation is required:

• Patient’s diagnosis of breast cancer
• Specific details of the mRNA microarray gene expression profiling, including the number of content genes and housekeeping genes analyzed
• Information about the tissue sample used, whether fresh frozen or formalin-fixed paraffin-embedded
• Date of the analysis
• Results of the algorithmic analysis, reported as an index related to the risk of distant metastasis
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 81521, ensure that the analysis is performed on fresh frozen or formalin-fixed paraffin-embedded tissue samples from a breast tumor. Do not report CPT code 81521 in conjunction with CPT code 81523 for the same specimen. Additional prep work, such as tissue selection or microdissection, may be separately reported if documented. It is important to note that MAAA codes, including CPT code 81521, include all the underlying lab tests, so separate reporting of technical lab tests is not necessary.

8. Historical information

CPT code 81521 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A patient with early-stage breast cancer undergoes mRNA microarray gene expression profiling using fresh frozen tissue, and the algorithmic analysis reports a high-risk score for distant metastasis.
2. A formalin-fixed paraffin-embedded tissue sample from a breast tumor is analyzed using mRNA microarray technology, and the algorithmic analysis reports a low-risk score for distant metastasis in a patient with early-stage breast cancer.
3. A lab analyst performs gene expression profiling of 70 content genes and 465 housekeeping genes in fresh frozen tissue from a breast tumor, and the algorithmic analysis reports an intermediate-risk score for distant metastasis in a patient with early-stage breast cancer.
4. An oncologist orders the analysis of gene expression in a formalin-fixed paraffin-embedded tissue sample from a breast tumor using mRNA microarray technology to assess the risk of distant metastasis in a patient with early-stage breast cancer.
5. A patient with early-stage breast cancer undergoes mRNA microarray gene expression profiling using fresh frozen tissue, and the algorithmic analysis reports a high-risk score for distant metastasis.
6. A formalin-fixed paraffin-embedded tissue sample from a breast tumor is analyzed using mRNA microarray technology, and the algorithmic analysis reports a low-risk score for distant metastasis in a patient with early-stage breast cancer.
7. A lab analyst performs gene expression profiling of 70 content genes and 465 housekeeping genes in fresh frozen tissue from a breast tumor, and the algorithmic analysis reports an intermediate-risk score for distant metastasis in a patient with early-stage breast cancer.
8. An oncologist orders the analysis of gene expression in a formalin-fixed paraffin-embedded tissue sample from a breast tumor using mRNA microarray technology to assess the risk of distant metastasis in a patient with early-stage breast cancer.