How To Use CPT Code 81554

CPT 81554 describes the mRNA gene expression analysis of 190 genes associated with pulmonary disease, specifically idiopathic pulmonary fibrosis (IPF), using transbronchial biopsies. 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 81554?

CPT 81554 can be used to describe the mRNA gene expression analysis of 190 genes associated with pulmonary disease, particularly idiopathic pulmonary fibrosis (IPF), using transbronchial biopsies. This code is used when the lab analyst performs the technical lab test on a transbronchial biopsy specimen and carries out an algorithmic analysis to report a categorical result of positive or negative for a high probability of usual interstitial pneumonia (UIP).

2. Official Description

The official description of CPT code 81554 is: ‘Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm reported as categorical result (eg, positive or negative for high probability of usual interstitial pneumonia [UIP]).’

3. Procedure

1. The lab analyst performs the technical lab test on a transbronchial biopsy specimen.
2. The lab analyst extracts nucleic acids from the specimen and increases the quantity of 190 nucleic acid markers.
3. The lab analyst may use next-generation sequencing or reverse transcription PCR (RT-PCR) to amplify and quantify genes.
4. The lab analyst carries out an algorithmic analysis using patient data and the lab test results.
5. The lab analyst reports a categorical result of positive or negative for a high probability of usual interstitial pneumonia (UIP).

4. Qualifying circumstances

CPT 81554 is used when a transbronchial biopsy specimen is analyzed for mRNA gene expression profiling of 190 genes associated with pulmonary disease, specifically idiopathic pulmonary fibrosis (IPF). The analysis aims to determine the presence or absence of a high probability of usual interstitial pneumonia (UIP). This test is typically ordered when radiologic and pathologic studies are inconclusive in identifying UIP, and a definitive diagnosis is needed to guide treatment options and reduce the need for surgical lung biopsy.

5. When to use CPT code 81554

CPT code 81554 should be used when a transbronchial biopsy specimen is analyzed for mRNA gene expression profiling of 190 genes associated with pulmonary disease, particularly idiopathic pulmonary fibrosis (IPF). This code is appropriate when the lab test results are used to report a categorical result of positive or negative for a high probability of usual interstitial pneumonia (UIP).

6. Documentation requirements

To support a claim for CPT 81554, the documentation should include:

• Indication for the test, such as inconclusive radiologic and pathologic studies
• Details of the transbronchial biopsy specimen
• Lab test results for mRNA gene expression profiling of 190 genes
• Algorithmic analysis using patient data
• Categorical result of positive or negative for a high probability of usual interstitial pneumonia (UIP)

7. Billing guidelines

When billing for CPT 81554, ensure that the test is performed on a transbronchial biopsy specimen and that the lab provides a categorical result of positive or negative for a high probability of usual interstitial pneumonia (UIP). This code includes both the technical lab test and the algorithmic analysis. Do not report additional technical lab tests separately. If there is no specific Category I or administrative code for a similar MAAA test, use the unlisted MAAA code 81599.

8. Historical information

CPT 81554 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs mRNA gene expression analysis of 190 genes associated with pulmonary disease on a transbronchial biopsy specimen and reports a categorical result of positive for a high probability of usual interstitial pneumonia (UIP).
2. A patient with suspected idiopathic pulmonary fibrosis (IPF) undergoes a transbronchial biopsy, and the lab analyzes the specimen for mRNA gene expression profiling of 190 genes. The lab reports a categorical result of negative for a high probability of usual interstitial pneumonia (UIP).
3. A physician orders mRNA gene expression analysis of 190 genes on a transbronchial biopsy specimen to confirm the presence of usual interstitial pneumonia (UIP) in a patient with pulmonary disease. The lab reports a categorical result of positive for a high probability of UIP.
4. A lab technician performs mRNA gene expression analysis of 190 genes on a transbronchial biopsy specimen and reports a categorical result of negative for a high probability of usual interstitial pneumonia (UIP).
5. A patient with suspected idiopathic pulmonary fibrosis (IPF) undergoes a transbronchial biopsy, and the lab analyzes the specimen for mRNA gene expression profiling of 190 genes. The lab reports a categorical result of positive for a high probability of usual interstitial pneumonia (UIP).
6. A physician orders mRNA gene expression analysis of 190 genes on a transbronchial biopsy specimen to confirm the absence of usual interstitial pneumonia (UIP) in a patient with pulmonary disease. The lab reports a categorical result of negative for a high probability of UIP.
7. A lab technician performs mRNA gene expression analysis of 190 genes on a transbronchial biopsy specimen and reports a categorical result of positive for a high probability of usual interstitial pneumonia (UIP).