How To Use CPT Code 81536

CPT 81536 describes the process of live tumor cell culture and chemotherapeutic response analysis for gynecologic oncology. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81536?

CPT 81536 can be used to describe the process of live tumor cell culture and chemotherapeutic response analysis for gynecologic oncology. This code is used when a lab analyst performs the technical lab steps to culture live tumor cells from specimens taken from female reproductive organs or tissues. The analyst then examines the culture for cell morphology and cell staining using 4’–6–diamidino–2–phenylindole (DAPI). Additionally, a predictive algorithm analysis is performed to determine a drug response score for a single drug or drug combination.

2. Official Description

The official description of CPT code 81536 is: ‘Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure)’. This code should be used in conjunction with CPT code 81535.

3. Procedure

1. The lab analyst isolates and cultures live tumor cells from a gynecological specimen.
2. The analyst examines cell morphology and performs DAPI staining to evaluate the tumor for drug susceptibility.
3. The lab analyst inputs the test results and patient information into a computer program.
4. A predictive algorithm analysis is performed using the specific algorithm.
5. A drug response score for a single drug or drug combination is reported to predict the susceptibility of the tumor to that chemotherapy agent.
6. If additional drug response scores are needed, each additional single drug or drug combination should be listed separately in addition to the code for the primary procedure.

4. Qualifying circumstances

CPT 81536 is used for gynecologic oncology cases where live tumor cell culture and chemotherapeutic response analysis are necessary. This procedure is performed to predict the expected response of the tumor to a specific chemotherapy agent or combination. It is important to note that CPT 81536 should be reported in conjunction with CPT code 81535 for the first single drug or drug combination response score, and each additional drug response score should be reported separately.

5. When to use CPT code 81536

CPT code 81536 should be used when live tumor cell culture and chemotherapeutic response analysis are performed for gynecologic oncology cases. It is appropriate to bill this code when evaluating the tumor’s susceptibility to specific chemotherapy agents or combinations. However, it is important to ensure that CPT code 81535 is also reported for the first drug response score, and each additional drug response score should be listed separately.

6. Documentation requirements

To support a claim for CPT code 81536, the following documentation is required:

• Details of the gynecologic specimen used for live tumor cell culture
• Results of cell morphology examination and DAPI staining
• Patient information, including relevant medical history
• Specific algorithm used for the predictive analysis
• Drug response score for each drug or drug combination
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT code 81536, it is important to ensure that the primary procedure code, CPT code 81535, is also reported for the first drug response score. Each additional drug response score should be listed separately. It is crucial to follow the specific guidelines provided by payers regarding the use of MAAA codes and the reporting of underlying test codes. Additionally, it is important to note that CPT code 81536 is an add-on code and should not be reported without an appropriate primary code.

8. Historical information

CPT code 81536 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 lab analyst performs live tumor cell culture and chemotherapeutic response analysis for a gynecologic oncology case, evaluating the tumor’s susceptibility to a specific chemotherapy agent.
2. Using a gynecologic specimen, the lab analyst examines cell morphology and performs DAPI staining to predict the tumor’s response to a drug combination.
3. In a gynecologic oncology case, the lab analyst reports a drug response score for a single drug, indicating the tumor’s susceptibility to that specific chemotherapy agent.
4. For a patient with gynecologic cancer, the lab analyst performs live tumor cell culture and chemotherapeutic response analysis, reporting a drug response score for each additional drug combination.
5. In a gynecologic oncology case, the lab analyst uses a predictive algorithm to determine the tumor’s susceptibility to a single chemotherapy drug.
6. A gynecologic specimen is used to culture live tumor cells, and the lab analyst performs chemotherapeutic response analysis to predict the tumor’s response to a specific drug combination.
7. For a gynecologic oncology case, the lab analyst reports a drug response score for a single drug, indicating the tumor’s susceptibility to that specific chemotherapy agent.
8. In a gynecologic oncology case, the lab analyst performs live tumor cell culture and chemotherapeutic response analysis, reporting a drug response score for each additional drug combination.
9. A lab analyst examines cell morphology and performs DAPI staining on live tumor cells from a gynecologic specimen to evaluate the tumor’s response to a specific chemotherapy agent.