How To Use CPT Code 81540

CPT 81540 describes the use of gene expression profiling to classify tumors of unknown origin into main cancer types and subtypes. 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 81540?

CPT 81540 can be used to classify tumors of unknown origin into main cancer types and subtypes using gene expression profiling. This code involves the analysis of 92 genes using real-time reverse transcription-polymerase chain reaction (RT-PCR) on formalin-fixed paraffin-embedded tumor tissue. The results are then processed through an algorithm to determine the probability of the predicted main cancer type and subtype.

2. Official Description

The official description of CPT code 81540 is: ‘Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype.’

3. Procedure

1. The lab analyst performs real-time RT-PCR on formalin-fixed paraffin-embedded tumor tissue to measure the activity of 92 genes.
2. An algorithmic analysis is carried out using patient data and the lab test results to determine the probability of the predicted main cancer type and subtype.
3. The lab analyst reports the results as a probability of the predicted main cancer type and subtype.

4. Qualifying circumstances

CPT 81540 is used when classifying tumors of unknown origin into main cancer types and subtypes. This test is typically ordered by clinicians to help identify the main cancer type and subtype for tumors with an unknown origin.

5. When to use CPT code 81540

CPT code 81540 should be used when there is a need to classify tumors of unknown origin into main cancer types and subtypes using gene expression profiling. It is important to note that this code should not be used for testing specific conditions, but rather for tumors with an unknown origin.

6. Documentation requirements

To support a claim for CPT 81540, the documentation should include:

• Information on the tumor of unknown origin
• Details of the gene expression profiling test performed
• Results of the algorithmic analysis
• Probability of the predicted main cancer type and subtype

7. Billing guidelines

When billing for CPT 81540, it is important to follow the specific guidelines. This code should not be reported with other codes, as it includes all the necessary lab tests and analysis. Medicare and some other payers may not accept CPT 81540 and may require billing only the underlying test codes.

8. Historical information

CPT 81540 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 presents with a tumor of unknown origin, and gene expression profiling is performed using CPT 81540 to classify the tumor into a main cancer type and subtype.
2. A clinician orders CPT 81540 for a patient with a tumor of unknown origin to determine the main cancer type and subtype for appropriate treatment planning.
3. A lab analyst performs real-time RT-PCR on formalin-fixed paraffin-embedded tumor tissue using CPT 81540 to classify the tumor into a main cancer type and subtype.
4. CPT 81540 is used to classify a tumor of unknown origin into a main cancer type and subtype, providing valuable information for the patient’s oncologist.
5. A patient undergoes gene expression profiling using CPT 81540 to determine the main cancer type and subtype of their tumor, aiding in personalized treatment decisions.
6. A tumor board reviews the results of CPT 81540, which classified a tumor of unknown origin into a specific main cancer type and subtype, guiding the multidisciplinary team in developing a treatment plan.
7. Gene expression profiling with CPT 81540 is performed on a tumor of unknown origin, providing crucial information for the pathologist to accurately classify the tumor.
8. CPT 81540 is used to classify a tumor into a main cancer type and subtype, helping to identify potential targeted therapies for the patient.
9. A patient’s tumor, which could not be identified by traditional methods, is successfully classified into a main cancer type and subtype using CPT 81540, allowing for more targeted treatment options.
10. Gene expression profiling with CPT 81540 is performed on a tumor of unknown origin, providing valuable insights into the tumor’s molecular characteristics and potential treatment options.