How To Use CPT Code 81525

CPT 81525 describes the analysis of gene expression in colon tumor tissue using real-time reverse transcription polymerase chain reaction (RT-PCR) of 12 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 81525?

CPT 81525 is used to analyze gene expression in colon tumor tissue. This involves performing real-time reverse transcription polymerase chain reaction (RT-PCR) on 12 specific genes. The results of this analysis are used to calculate a recurrence score for the patient.

2. Official Description

The official description of CPT code 81525 is: ‘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.’

3. Procedure

1. The lab analyst performs real-time RT-PCR on colon tumor tissue to measure the activity of 12 specific genes.
2. The lab analyst inputs the test results and patient information into a computer program.
3. A specific algorithm is used to analyze the data and calculate a recurrence score for the patient.
4. The recurrence score is reported as the final result of the analysis.

4. Qualifying circumstances

CPT 81525 is used when analyzing gene expression in colon tumor tissue to predict the chance of neoplasm recurrence following tumor resection in patients with colon cancer. This test is typically ordered by clinicians to assess the likelihood of recurrence in these patients.

5. When to use CPT code 81525

CPT code 81525 should be used when performing gene expression profiling in colon tumor tissue using real-time RT-PCR of 12 specific genes. This code is appropriate for predicting the risk of neoplasm recurrence in patients with colon cancer.

6. Documentation requirements

To support a claim for CPT 81525, the following documentation is required:

• Documentation of the specific genes analyzed using real-time RT-PCR
• Documentation of the formalin-fixed paraffin-embedded tissue used for the analysis
• Documentation of the algorithm used to calculate the recurrence score
• Documentation of the recurrence score reported as the final result

7. Billing guidelines

When billing for CPT 81525, it is important to ensure that the analysis is performed on colon tumor tissue using real-time RT-PCR of 12 genes. This code should not be reported separately for the underlying lab tests, as the MAAA code already includes these tests. It is also important to note that Medicare and some other payers may not accept MAAA codes and may require billing only the underlying test codes.

8. Historical information

CPT 81525 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A patient with colon cancer undergoes gene expression profiling using real-time RT-PCR of 12 genes to determine their recurrence score.
2. A clinician orders CPT 81525 to assess the risk of neoplasm recurrence in a patient who has undergone colon tumor resection.
3. A lab analyst performs real-time RT-PCR on colon tumor tissue and calculates the recurrence score using the algorithm.
4. A patient with a history of colon cancer undergoes gene expression analysis to determine their likelihood of recurrence following treatment.
5. A clinician uses CPT 81525 to guide treatment decisions for a patient with colon cancer based on their recurrence score.
6. A lab technician analyzes gene expression in colon tumor tissue using real-time RT-PCR of 12 genes to predict the risk of neoplasm recurrence.
7. A patient’s colon tumor tissue is analyzed using CPT 81525 to determine their recurrence score and guide further treatment options.
8. A clinician orders gene expression profiling using real-time RT-PCR of 12 genes to assess the risk of neoplasm recurrence in a patient with colon cancer.
9. A lab analyst performs real-time RT-PCR on colon tumor tissue and reports the recurrence score using CPT 81525.
10. A patient’s recurrence score is calculated using the algorithm after gene expression analysis of their colon tumor tissue using real-time RT-PCR of 12 genes.