How To Use CPT Code 81538

CPT 81538 describes the use of a prognostic and predictive algorithm to evaluate serum samples for lung cancer patients. 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 81538?

CPT 81538 can be used to report the evaluation of serum samples from lung cancer patients using a prognostic and predictive algorithm. This code is used when a lab analyst performs mass spectrometry to analyze the levels of eight specific proteins, including amyloid A, in the specimen. The lab analyst then uses a computer program to input the test results and other patient data to generate a report indicating whether the patient has a good or poor overall survival likelihood from lung cancer.

2. Official Description

The official description of CPT code 81538 is: ‘Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival.’

3. Procedure

1. The lab analyst processes the serum sample and performs mass spectrometry to evaluate the levels of eight specific proteins, including amyloid A.
2. The lab analyst inputs the test results and other patient data into a computer program.
3. The computer program uses a prognostic and predictive algorithm to analyze the data and generate a report indicating whether the patient has a good or poor overall survival likelihood from lung cancer.

4. Qualifying circumstances

CPT 81538 is used for patients with lung cancer who require an evaluation of their overall survival likelihood. The test involves the analysis of serum samples using mass spectrometry and a prognostic and predictive algorithm. It is important to note that this code is specific to lung cancer and should not be used for testing related to other conditions.

5. When to use CPT code 81538

CPT code 81538 should be used when evaluating the overall survival likelihood of lung cancer patients using a prognostic and predictive algorithm. It is important to ensure that the test is performed on serum samples and that the analysis includes the evaluation of eight specific proteins, including amyloid A. This code should not be used for testing related to other types of cancer or conditions.

6. Documentation requirements

To support a claim for CPT 81538, the following documentation is required:

• Patient information, including the diagnosis of lung cancer
• Details of the serum sample analysis, including the specific proteins evaluated
• Results of the prognostic and predictive algorithm analysis
• Report indicating whether the patient has a good or poor overall survival likelihood from lung cancer

7. Billing guidelines

When billing for CPT 81538, ensure that the test is performed on serum samples and that the analysis includes the evaluation of eight specific proteins, including amyloid A. It is important to follow the specific guidelines provided by payers regarding the use of this code. Additionally, do not report CPT 81538 with other codes unless specifically instructed to do so by the payer.

8. Historical information

CPT 81538 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 mass spectrometry on a serum sample from a lung cancer patient and inputs the test results into a computer program. The program generates a report indicating a good overall survival likelihood for the patient.
2. Using a serum sample, a lab analyst analyzes the levels of eight specific proteins, including amyloid A, in a lung cancer patient. The prognostic and predictive algorithm indicates a poor overall survival likelihood for the patient.
3. For a lung cancer patient, a lab analyst evaluates a serum sample using mass spectrometry and a prognostic and predictive algorithm. The analysis reveals a good overall survival likelihood for the patient.
4. A serum sample from a lung cancer patient is analyzed by a lab analyst using mass spectrometry and a prognostic and predictive algorithm. The resulting report indicates a poor overall survival likelihood for the patient.
5. Using a prognostic and predictive algorithm, a lab analyst evaluates a serum sample from a lung cancer patient. The analysis of the eight specific proteins, including amyloid A, indicates a good overall survival likelihood for the patient.
6. A lab analyst performs mass spectrometry on a serum sample from a lung cancer patient and inputs the test results into a computer program. The program generates a report indicating a poor overall survival likelihood for the patient.
7. Using a serum sample, a lab analyst analyzes the levels of eight specific proteins, including amyloid A, in a lung cancer patient. The prognostic and predictive algorithm indicates a good overall survival likelihood for the patient.
8. For a lung cancer patient, a lab analyst evaluates a serum sample using mass spectrometry and a prognostic and predictive algorithm. The analysis reveals a poor overall survival likelihood for the patient.
9. A serum sample from a lung cancer patient is analyzed by a lab analyst using mass spectrometry and a prognostic and predictive algorithm. The resulting report indicates a good overall survival likelihood for the patient.
10. Using a prognostic and predictive algorithm, a lab analyst evaluates a serum sample from a lung cancer patient. The analysis of the eight specific proteins, including amyloid A, indicates a poor overall survival likelihood for the patient.