CPT Code Overview

CPT code 81446 is used for genomic sequence analysis panels targeting solid organ neoplasms, specifically DNA analysis of 5 to 50 genes. This procedure falls under the Pathology and Laboratory service type and is typically performed in an Independent Laboratory setting (Place of Service 81). The test is designed to provide comprehensive genetic information that can inform diagnosis and treatment strategies for patients with solid organ tumors.

Clinical Context

A patient diagnosed with a solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests a genomic sequence analysis panel to identify DNA mutations across 5-50 genes relevant to the neoplasm. The specimen, typically a tissue biopsy from the affected organ, is sent to an independent laboratory (Place of Service 81) specializing in pathology and molecular diagnostics. The laboratory performs the genomic sequencing to guide targeted therapy decisions and inform prognosis. Results are interpreted by a pathologist or molecular oncologist and reported back to the treating physician for integration into the patient's care plan.

Coding Specifications

• Modifiers:

  • Modifier 26: Indicates the professional component, used when the physician interprets the results but does not perform the technical aspects of the test.
  • Modifier TC: Indicates the technical component, used when the laboratory performs the test but does not provide interpretation.

• Provider Taxonomies:

• Specialties Represented:

  • Pathologists
  • Anatomic Pathologists
  • Medical Oncologists

Related Diagnoses

• C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung

  • Relevant for patients with lung cancer undergoing genomic analysis to identify actionable mutations.

• C50.919: Malignant neoplasm of unspecified site of unspecified female breast

  • Used for breast cancer cases where genomic sequencing may inform targeted therapy.

• C18.9: Malignant neoplasm of colon, unspecified

  • Applied to colon cancer patients to detect genetic alterations for personalized treatment.

• C61: Malignant neoplasm of prostate

  • Pertinent for prostate cancer, where genomic profiling can guide therapy selection.

• C25.9: Malignant neoplasm of pancreas, unspecified

  • Used for pancreatic cancer patients to identify mutations relevant to prognosis and treatment.

Related CPT Codes

• 81445: Genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes

  • Closely related to 81446, often used as an alternative depending on panel specifics.

• 88342: Immunohistochemistry, per specimen; initial single antibody stain procedure

  • Used to assess protein expression in tumor tissue, commonly performed alongside genomic sequencing for comprehensive tumor profiling.

• 88341: Immunohistochemistry, per specimen; each additional single antibody stain procedure

  • Used when multiple antibody stains are required, often in conjunction with 88342 and genomic testing.

• 81235: EGFR (epidermal growth factor receptor) gene analysis, common variants

  • Targeted gene analysis, may be ordered separately or as part of a broader panel like 81446 for lung cancer cases.

• Common Clinical Workflow:

  • 81446 may be ordered with 88342 and 88341 for integrated molecular and immunohistochemical tumor profiling.
  • 81235 is sometimes used as a standalone test or included in the gene panel for specific cancers.