AMA CPT® Assistant - 2017 Issue 4 (April)
Pathology and Laboratory: Molecular Pathology (Q&A) (April 2017)
April 2017 page 10a Pathology and Laboratory: Molecular Pathology Question: For gene sequencing of 11-25 exons, is it appropriate to report code 81406 when the gene is not specifically mentioned in the code descriptor, but matches the procedure definition? Answer: No, if the analyte tested is not specifically listed under a Tier 2 code, the Tier 2 code should not be reported. Tier 2 codes cannot be reported for tests other than those listed in the code. When reporting the testing of an analyte that isn't listed under one of the Tier 2 codes, it would be appropriate to...
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Article Overview
This article reviews a molecular pathology coding question from CPT Assistant and clarifies the broad approach to reporting gene sequencing services when the tested analyte is not specifically identified in a Tier 2 code. It is relevant to pathology and laboratory coders, billers, and compliance staff who work with CPT molecular pathology reporting and claim documentation.
Why This Topic Matters
Accurate molecular pathology reporting depends on using the correct CPT pathway for tests that are or are not explicitly enumerated in the code set. This guidance helps readers understand the general scope of the issue and the kind of documentation that may be involved when an unlisted molecular pathology service is reported.
Article Sections
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April 2017 page 10a
An introductory page reference for the molecular pathology Q&A content in this issue.
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Pathology and Laboratory: Molecular Pathology
A question-and-answer discussion of molecular pathology coding policy within the pathology and laboratory domain.
What You Will Learn
- The general CPT framework addressed for molecular pathology reporting
- How the article distinguishes analyte-specific reporting from unlisted services
- What kinds of supporting documentation are discussed for unlisted molecular pathology claims
- Which professional audience would most benefit from the guidance
Who Should Read This
- Pathologists
- Laboratory coders
- Medical billers
- Coding compliance staff
- Revenue cycle professionals
Codes Discussed
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