Clinical Context
A 62-year-old patient with newly diagnosed acute myelogenous leukemia (AML) presents to a hematology/oncology clinic after abnormal peripheral blood counts and a confirmatory bone marrow biopsy. The treating hematologist orders the MyAML™ NGS Panel (0050U) by LabPMM LLC to identify sequence and copy number variants across 194 genes associated with AML. A peripheral blood or bone marrow aspirate specimen is collected in appropriate EDTA or preservative tubes and sent to the performing laboratory. The laboratory performs next-generation targeted sequencing and bioinformatic analysis, reports pathogenic and likely pathogenic variants, and provides a clinical report to the ordering provider to guide prognosis, targeted therapy selection, and eligibility for clinical trials. Typical workflow steps include specimen collection, requisition and test ordering by the hematologist, courier transport to the reference laboratory, laboratory processing and sequencing, result validation by laboratory personnel, and result delivery to the ordering provider. Common sites of service are hospital inpatient settings, outpatient hematology/oncology clinics, and independent reference laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Default/No modifier | General reporting when no specific modifier applies. |
11 | Professional Component | When reporting the professional interpretation component separately (rare for PLA tests; used if local lab only provides interpretation).
26 | Professional Component | Used when a physician provides the interpretation component distinct from technical services.
52 | Reduced Services | When the laboratory provides a partial or limited version of the test.
53 | Discontinued Procedure | If testing was begun but discontinued for clinical reasons prior to completion.
62 | Two Surgeons/Providers | Applicable if two qualified providers share responsibility for interpretation in unusual multi-provider consults.
78 | Unplanned Return to OR | Not typically applicable; retained for completeness when procedure-related re-interventions occur.
80 | Assistant Surgeon | Not typically applicable to laboratory testing but included where an assisting provider participates in specimen procurement.
AD | Reported per diem/Not applicable (PLA-specific payer modifiers) | Some payers use manufacturer-specific modifiers; used per payer rules when required.
QX | Ordering Physician-Provided Clinical Lab Test | Use when the ordering physician also performs the diagnostic test in their office-lab under CLIA rules.
| Taxonomy Code | Specialty | Notes |
|---|
207RH0000X | Hematology & Oncology | Ordering providers who manage AML diagnosis and direct molecular testing. |
207RG0300X | Hematology | Hematologists who diagnose and follow AML; commonly order MLA panels.
208000000X | Pathology | Molecular pathologists who interpret NGS results and sign out reports.
2086P0202X | Molecular Genetic Pathology | Specialists performing and interpreting advanced molecular diagnostics.
363LP0800X | Clinical Laboratory | Clinical laboratory directors and technologists responsible for test performance and reporting.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
C92.0 | Acute myeloblastic leukemia, not having achieved remission | Primary AML diagnosis often prompting comprehensive NGS panel testing to identify actionable mutations. |
C92.00 | Acute myeloblastic leukemia not having achieved remission, without maturation | Specific AML subtype frequently evaluated with mutation profiling for prognosis and therapy.
C92.01 | Acute myeloblastic leukemia not having achieved remission, with maturation | Subclassification of AML where molecular profiling informs risk stratification.
C92.10 | Acute myelomonocytic leukemia, not having achieved remission | AML variant where targeted sequencing assists therapeutic decisions.
D47.Z2 | Other chronic myeloproliferative disease, unspecified | Disorders with potential progression to AML where NGS may be used to assess transformation risk.
Z51.11 | Encounter for antineoplastic chemotherapy | Patients undergoing or planning chemotherapy often require molecular profiling to guide regimen selection.
R76.8 | Other specified abnormal immunological findings | Abnormal laboratory findings prompting further molecular diagnostic evaluation in hematologic disease.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
80053 | Comprehensive metabolic panel | Pre-testing labs often performed to assess organ function prior to therapy decisions influenced by molecular results. |
88185 | Flow cytometry, immunophenotyping (per specimen) | Performed in parallel to NGS for lineage confirmation and immunophenotypic classification of AML.
80999 | Unlisted chemistry procedure | Occasionally used for ancillary or novel laboratory procedures not otherwise classified when needed alongside PLA testing.
81301 | SMN1 (sequence analysis) example molecular code | Represents single-gene molecular testing that may be ordered when targeted single-gene confirmation is required in addition to panel testing.
88240 | Molecular cytogenetics; FISH, probe panels | Cytogenetic or FISH testing commonly performed alongside NGS to detect translocations and copy number changes relevant to AML.