CPT® Code 0280T | Case2Code

Code deleted, see 86152, 86153

Official Description

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

Common Language Description

Cell enumeration using immunologic selection and identification in fluid specimens, such as circulating tumor cells in blood, represents an advanced technique for monitoring disease progression in patients diagnosed with certain types of cancer, including breast, colorectal, and prostate cancers. This innovative method involves a multistep process that utilizes specialized testing equipment to accurately identify and quantify tumor cells present in the bloodstream. Initially, a blood sample is collected using a designated collection kit, ensuring the integrity of the specimen. Following collection, the sample undergoes centrifugation to separate the plasma from the cellular components. The remaining cells are then mixed with a buffer solution and a reagent that is conjugated with a monoclonal antibody specifically designed to bind to epithelial cells. This selective binding allows for the separation of the epithelial cells from other cellular debris and leukocytes. A magnet is employed to facilitate this separation, attracting the bound epithelial cells while the unbound cells and excess fluid are discarded. Subsequently, the bound cells are subjected to a staining process using three distinct stains that help differentiate viable epithelial cells from any contaminating leukocytes or debris. Once stained, a magnet is again utilized to draw the labeled epithelial cells to the surface of a testing cartridge. A fluorescence-based microscopy system is then used to capture images of the cells at the cartridge's surface. A qualified technologist reviews these images to identify tumor cells based on their specific phenotype and the presence or absence of the designated stains. It is important to note that while CPT® Code 0279T covers the technical laboratory component of this cell enumeration process, CPT® Code 0280T pertains to the professional component, which includes the physician's review, interpretation of the results, and the generation of a written report detailing the findings.

1. Indications

Cell enumeration using immunologic selection and identification in fluid specimens is indicated for the monitoring of disease progression in patients diagnosed with specific types of cancer. The following conditions are explicitly mentioned as indications for this procedure:

Breast Cancer This procedure is utilized to monitor the presence and progression of circulating tumor cells in patients diagnosed with breast cancer.
Colorectal Cancer It is indicated for patients with colorectal cancer to assess disease progression through the enumeration of circulating tumor cells.
Prostate Cancer The procedure is also applicable for monitoring circulating tumor cells in patients diagnosed with prostate cancer.

2. Procedure

The procedure for cell enumeration using immunologic selection and identification involves several detailed steps to ensure accurate identification of circulating tumor cells. The following steps outline the process:

Step 1: Blood Sample Collection A blood sample is obtained from the patient using a specialized collection kit designed to preserve the integrity of the specimen for subsequent analysis.
Step 2: Centrifugation The collected blood sample is subjected to centrifugation, which separates the plasma from the cellular components, allowing for the isolation of the cells needed for analysis.
Step 3: Mixing with Buffer and Reagent 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, facilitating their identification.
Step 4: Separation of Bound Cells A magnet is used to attract the bound epithelial cells away from other cells and debris, effectively isolating them for further analysis. The unbound cells and excess fluid are then removed.
Step 5: Staining of Cells The bound epithelial cells are stained using three different stains that help distinguish viable epithelial cells from any contaminating leukocytes or debris, enhancing the accuracy of the identification process.
Step 6: Attraction of Labeled Cells A magnet is again employed to attract the labeled epithelial cells to the surface of a testing cartridge, preparing them for imaging.
Step 7: Imaging and Review A fluorescence-based microscopy system captures images of the cells at the surface of the cartridge. A qualified technologist then reviews these images to identify tumor cells based on their phenotype and the presence or absence of specific stains.

3. Post-Procedure

After the completion of the cell enumeration procedure, the physician conducts a thorough review of the images obtained from the fluorescence microscopy system. The interpretation of the findings is documented in a written report, which details the presence and characteristics of any identified circulating tumor cells. This report is essential for guiding further clinical decisions and monitoring the patient's disease progression. The results may also be used to inform treatment strategies and assess the effectiveness of ongoing therapies. Follow-up care and additional testing may be recommended based on the findings reported.

Short Descr	CTC TEST W/I & R
Medium Descr	CELL ENUMRATION W/IMMUN SELXN ID FLUID SPEC I&R
Long Descr	Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); interpretation and report
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