How To Use CPT Code 81546

CPT 81546 describes the mRNA gene expression analysis of 10,196 genes in an oncology (thyroid) setting, utilizing a fine needle aspirate. 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 81546?

CPT 81546 can be used to describe the mRNA gene expression analysis of 10,196 genes in an oncology (thyroid) setting. This code is specifically used for analyzing the gene expression in a fine needle aspirate specimen from the thyroid. The analysis is performed using an algorithm to determine a categorical result, such as “benign” or “suspicious,” for thyroid cancer.

2. Official Description

The official description of CPT code 81546 is: ‘Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious).’

3. Procedure

1. The lab analyst performs technical lab tests on a fine needle aspiration (FNA) thyroid specimen sample.
2. Nucleic acids are extracted from the specimen using methods such as cell lysis and digestion.
3. The lab increases the quantity of 10,196 nucleic acid markers and stabilizes them.
4. The lab may use next-generation sequencing or reverse transcription PCR (RT-PCR) to create copy DNA (cDNA) from the specimen mRNA.
5. The lab amplifies and quantifies the genes using methods such as real-time (quantitative) PCR (qPCR).
6. The lab processes the lab test result and patient data using a computer algorithm.
7. The lab reports a categorical result, such as “benign” or “suspicious,” for thyroid cancer based on the algorithmic analysis.

4. Qualifying circumstances

CPT 81546 is used when analyzing the gene expression in a fine needle aspirate specimen from the thyroid. It is typically ordered by clinicians to assess whether the specimen is benign or suspicious for thyroid cancer. The test evaluates mRNA gene expression of 10,196 genes, providing information on which genes are actively expressed or “turned on” in the cancerous cells. This information helps guide further treatment decisions, such as surgery.

5. When to use CPT code 81546

CPT code 81546 should be used when performing mRNA gene expression analysis of 10,196 genes in an oncology (thyroid) setting using a fine needle aspirate specimen. It is specifically used to determine a categorical result, such as “benign” or “suspicious,” for thyroid cancer. This code should not be used for other types of gene expression analysis or for specimens from different anatomical sites.

6. Documentation requirements

To support a claim for CPT 81546, the documentation should include:

• Indication for the test, such as suspicion of thyroid cancer
• Details of the fine needle aspirate specimen, including the anatomical site
• Methodology used for mRNA gene expression analysis
• Results of the algorithmic analysis, including the categorical result
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81546, ensure that the test is performed on a fine needle aspirate specimen from the thyroid and that the algorithmic analysis is reported as a categorical result. It is important not to separately report any technical lab tests, as CPT 81546 includes all necessary components. Additionally, refer to the specific guidelines provided by payers to ensure accurate billing and reimbursement.

8. Historical information

CPT 81546 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a fine needle aspiration of the thyroid, and the mRNA gene expression analysis of 10,196 genes is performed. The algorithmic analysis reports a categorical result of “benign,” indicating no suspicion of thyroid cancer.
2. In another case, a fine needle aspirate specimen from the thyroid is analyzed for mRNA gene expression of 10,196 genes. The algorithmic analysis reports a categorical result of “suspicious,” indicating a potential presence of thyroid cancer.
3. A clinician orders the mRNA gene expression analysis of 10,196 genes on a fine needle aspirate specimen from the thyroid. The algorithmic analysis reveals a categorical result of “benign,” providing reassurance that the specimen is not indicative of thyroid cancer.
4. Using a fine needle aspirate specimen from the thyroid, the mRNA gene expression analysis of 10,196 genes is performed. The algorithmic analysis reports a categorical result of “suspicious,” prompting further evaluation and consideration of treatment options for thyroid cancer.
5. In a different case, a patient’s fine needle aspirate specimen from the thyroid is subjected to mRNA gene expression analysis of 10,196 genes. The algorithmic analysis yields a categorical result of “benign,” indicating no evidence of thyroid cancer.
6. Another patient undergoes a fine needle aspiration of the thyroid, and the mRNA gene expression analysis of 10,196 genes is performed. The algorithmic analysis reports a categorical result of “suspicious,” suggesting the need for additional diagnostic procedures to confirm or rule out thyroid cancer.