CPT® Code 0279T | Case2Code

Code deleted, see 86152, 86153

Official Description

Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);

Common Language Description

Cell enumeration using immunologic selection and identification in fluid specimens, as described by CPT® Code 0279T, refers to a specialized laboratory procedure aimed at identifying circulating tumor cells (CTCs) present in blood samples. This innovative method is particularly significant for monitoring disease progression in patients diagnosed with various types of cancer, including breast, colorectal, and prostate cancers. The process involves several intricate steps that utilize advanced testing equipment to ensure accurate identification of these cells. Initially, a blood sample is collected using a designated collection kit, which is crucial for maintaining the integrity of the specimen. Following collection, the sample undergoes centrifugation to separate the plasma from the cellular components. The remaining cells are then treated with a buffer solution and a reagent that is conjugated with a monoclonal antibody specifically designed to bind to epithelial cells. This selective binding is essential for isolating the target cells from other cellular debris. Once the epithelial cells are bound, a magnet is employed to separate them from unbound cells and other contaminants. The next step involves staining the bound cells with three distinct stains that help differentiate viable epithelial cells from any leukocytes or other debris that may be present. After staining, a magnet is again used to attract the labeled epithelial cells to the surface of a testing cartridge, where they can be visualized. A fluorescence-based microscopy system captures images of these cells, allowing a trained technologist to review and identify tumor cells based on their specific phenotype and the staining characteristics. This comprehensive approach to cell enumeration is critical for providing insights into the patient's cancer status and guiding treatment decisions. It is important to note that while CPT® Code 0279T covers the technical laboratory component of this procedure, the professional component, which includes physician review, interpretation, and a written report of findings, is designated under CPT® Code 0280T.

1. Indications

The procedure of cell enumeration using immunologic selection and identification is indicated for the following conditions:

Monitoring Disease Progression This procedure is performed to monitor the progression of certain types of cancer, particularly in patients diagnosed with breast, colorectal, and prostate cancers.

2. Procedure

The procedure for cell enumeration using immunologic selection and identification involves several detailed steps to ensure accurate identification of circulating tumor cells (CTCs) in blood samples:

Step 1: Blood Sample Collection A blood sample is obtained from the patient using a special collection kit designed to preserve the integrity of the specimen. This step is crucial as it ensures that the sample remains uncontaminated and suitable for further analysis.
Step 2: Centrifugation The collected blood sample is subjected to centrifugation, a process that separates the plasma from the cellular components. This separation is essential for isolating the cells that will be analyzed for the presence of circulating tumor cells.
Step 3: Preparation of Cellular Components After centrifugation, the remaining cellular components are mixed with a buffer solution and a reagent that is conjugated with a monoclonal antibody. This antibody specifically binds to epithelial cells, which is a critical step in the selection process.
Step 4: Separation of Bound Cells The bound epithelial cells are separated from other cells and debris using a magnet. This magnetic separation allows for the isolation of the target cells, ensuring that the analysis focuses on the relevant epithelial cells.
Step 5: Removal of Unbound Cells Following magnetic separation, the remaining fluid and any unbound cells are removed, leaving only the bound epithelial cells for further analysis.
Step 6: Staining of Cells The bound cells are then stained using three different stains that help distinguish viable epithelial cells from any contaminating leukocytes or other debris. This staining process is vital for accurate identification during the imaging phase.
Step 7: Imaging of Cells A magnet is again used to attract the labeled epithelial cells to the surface of a testing cartridge. A fluorescence-based microscopy system is then employed to acquire images of the cells at the surface of the cartridge, allowing for detailed visualization.
Step 8: Review and Identification A trained technologist reviews the acquired images and identifies tumor cells based on the circulating tumor cell phenotype and the presence or absence of specific stains in the cells. This final step is crucial for determining the presence of circulating tumor cells and assessing the patient's cancer status.

3. Post-Procedure

Post-procedure care for patients undergoing cell enumeration using immunologic selection and identification typically involves monitoring for any immediate reactions to the blood draw. Since this procedure is primarily laboratory-based, there are no specific recovery protocols required for the patient following the test. However, the results of the test will be reviewed by a physician, who will interpret the findings and provide a written report. This report is essential for guiding further treatment decisions and monitoring the patient's ongoing cancer management.

Short Descr	CTC TEST
Medium Descr	CELL ENUMRTION W/IMMUN SELXN & ID FLUID SPECIMN
Long Descr	Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	235 - Other Laboratory