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Pathology/Lab Coding Alert

CPT® 2019 for Labs:
Preview Numerous PLA and Tier 1 Molecular Pathology Codes

Update some chemistry options, too.

You need the scoop on 2019 clinical laboratory CPT® codes coming down the pike, and we’ve got the goods for you.

Based on our rundown of information presented at the CMS Annual Clinical Laboratory Public Meeting held June 25, 2018, here’s a sneak peek of what to expect Jan. 1, 2019.

Caution: The 2019 CPT® codes aren’t finalized, but CMS will determine the basis of payment for the new codes using comments from the meeting, according to CMS’s Glenn McGuirk, speaking at the event. You can access the proposed codes now, and the basis of payment when available later this fall, at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings.html.

Find Myriad PLA Codes

Introduced to CPT® last year, the Proprietary Laboratory Analyses (PLA) are alpha-numeric codes assigned with approval by the AMA CPT® Editorial Panel for unique lab tests that a specific clinical laboratory or test manufacturer produces or provides.

PLAs may be Advanced Diagnostic Laboratory Tests (ADLTs) or Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA).

At the June 25 public meeting, CMS heard stake-holder comments about pricing for nearly 45 new PLA codes (0018U - 0061U).

For neoplasm: Many of the tests target diagnosis or prognosis for cancers such as thyroid (0018U, 0026U), prostate (0021U, 0047U, 0053U), breast (0045U), lung (0022U), leukemia (0023U, 0040U, 0046U, 0049U, 0050U, 0056U), and solid organ neoplasia (0036U, 0037U, 0048U, 0057U).

Drug testing: Several other new PLA codes focus on drug tests, such as 0020U for presumptive identification with definitive confirmation, 0029U-0032U for drug metabolism, and 0054U for prescription drug monitoring.

Lyme disease: Four new PLA codes target Borellia detection: 0041U-0044U.

To read more about PLA codes, including how to apply for a code, and for a current list of AMA approved codes, visit www.ama-assn.org/practice-management/cpt-pla-codes.

Look for 45+ Novel Tier 1 Molecular Codes

In addition to PLA codes, CPT® 2019 will have many new codes in the Tier 1 molecular pathology section. Without the final code assignment, codes discussed at the annual laboratory public meeting included the following, among others:

  • Androgen receptor alleles, full gene sequence, and familial variants (8X003-8X005)
  • Ataxin alleles (8X007-8X012), ataxia-related CACNA1A mutations (8X013-8X015), FXN mutations (8X024-8X025), and TBP abnormal alleles (8X036)
  • New BRCA1, BRCA2 tests (81X78-81X83)
  • Dystrophy related genes such as CNBP (8X016), DMPK (8X017-8X018), SMN1 (8X032-8X034).

Learn Other Additions

CPT® 2019 will include new Multianalyte Assays with Algorithmic Analyses (MAAA) and genomic sequence procedure (GSP) codes, too.

For instance: You’ll find a new GSP code (81X43) for severe inherited conditions, and a new MAAA test for chronic hepatitis C virus (HCV) liver activity (815X0).

Novel chemistry tests for dihydrotestosterone (80X01) and small, dense LDL cholesterol (8372X) also earn new codes for the updated code set that will go into effect on Jan. 1.