October 12, 2015 - Revised 08.09.17
ResponseDX Tissue of Origin® Coding and Billing Guidelines (CM00030, V4)
Tissue of Origin®, a microarray - based gene expression assay, was designed to determine the similarity of unknown or unresolved tumors to cancers from 1 of 15 known tumors of origin.
To bill for Tissue of Origin services, please provide the following claim information:
- Claims received on and after 1/1/2015: CPT code 81504 - Oncology (tissue of origin)
- Enter '1' in the Days/Unit field
Enter Z - Code IdentifierTM in the comment/narrative field for the following claim field/types:
- Loop 2300 NTE01/SV202-7 for Part A or SV101-7 field for Part B
- Submit DEX Z - Code™ Identifier on an attachment to the claim form for paper claim (Form locator 80 for Part A or Box 19 for Part B)
Select the Appropriate ICD-10-CM diagnoses:
- C18.1 - Malignant neoplasm of appendix
- C18.9 – Malignant neoplasm of colon, unspecified
- C22.0 - Liver cell carcinoma
- C22.2 – Hepatoblastoma
- C22.3 – Angiosarcoma of liver
- C22.4 – Other Sarcomas of liver
- C22.7 – Other specified carcinomas of liver
- C22.8 – Malignant neoplasm of liver, primary, unspecified as to type
- C22.9 – Malignant neoplasm of liver, not specified as primary or secondary
- C25.2 – Malignant neoplasm of tail of pancreas
- C25.7 – Malignant neoplasm of other parts of the pancreas
- C25.8 – Malignant neoplasm of overlapping sites of pancreas
- C25.9 – Malignant neoplasm of pancreas, unspecified
- C33 – Malignant neoplasm of trachea
- C34.00 – Malignant neoplasm of unspecified main bronchus
- C34.01 – Malignant neoplasm of right main bronchus
- C34.02 – Malignant neoplasm of left main bronchus
- C34.10 – Malignant neoplasm of upper lobe, unspecified bronchus or lung
- C34.11 – Malignant neoplasm of upper lobe, right bronchus or lung
- C34.12 - Malignant neoplasm of upper lobe, left bronchus or lung
- C34.30 – Malignant neoplasm of lower lobe, unspecified bronchus or lung
- C34.31 – Malignant neoplasm of lower lobe, right bronchus or lung
- C34.32 – Malignant neoplasm of lower lobe, left bronchus or lung
- C34.80 – Malignant neoplasm of overlapping sites of unspecified bronchus and lung
- C34.81 – Malignant neoplasm of overlapping sites of right bronchus and lung
- C43.51 – Malignant melanoma of anal skin
- C43.52 – Malignant melanoma of skin of breast
- C43.59 – Malignant melanoma of other part of trunk
- C45.9 – Mesothelioma, unspecified
- C47.0 – Malignant neoplasm of peripheral nerves of head, face, and neck
- C47.9 – Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
- C48.0 – Malignant neoplasm of retroperitoneum
- C49.0 Malignant neoplasm of connective and soft tissue of head, face, and neck
- C49.9 – Malignant neoplasm of connective and soft tissue, unspecified
- C50.411 – Malignant neoplasm of upper - outer quadrant of right female breast
- C50.419 – Malignant neoplasm of upper - outer quadrant of left female breast
- C50.419 – Malignant neoplasm of upper - outer quadrant of unspecified female breast
- C50.511 – Malignant neoplasm of lower - outer quadrant of right female breast
- C50.512 – Malignant neoplasm of lower - outer quadrant of left female breast
- C50.519 – Malignant neoplasm of lower - outer quadrant of unspecified female breast
- C50.811 – Malignant neoplasm of overlapping sites of right female breast
- C50.812 – Malignant neoplasm of overlapping sites of left female breast
- C50.819 – Malignant neoplasm of overlapping sites of unspecified female breast
- C50.911 – Malignant neoplasm of unspecified site of right female breast
- C50.912 – Malignant neoplasm of unspecified site of left female breast
- C50.919 – Malignant neoplasm of unspecified site of unspecified female breast
- C56.1 – Malignant neoplasm of right ovary
- C56.2 – Malignant neoplasm of left ovary
- C56.9 – Malignant neoplasm of unspecified ovary
- C61 – Malignant neoplasm of prostate
- C64.1 – Malignant neoplasm of right kidney, except renal pelvis
- C64.2 –Malignant neoplasm of left kidney, expect renal pelvis
- C64.9 – Malignant neoplasm of unspecified kidney, except renal pelvis
- C67.5 – Malignant neoplasm of bladder neck
- C67.9 – Malignant neoplasm of bladder, unspecified
- C76.0 Malignant neoplasm of head, face and neck
- C77.0 – Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
- C77.1 – Secondary and unspecified malignant neoplasm of intrapelvia lymph nodes
- C77.2 – Secondary and unspecified malignant neoplasm of intra - abdominal lymph nodes
- C77.3 – Secondary unspecified malignant neoplasm of axilla and upper limb lymph nodes
- C77.4 – Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes
- C77.5 – Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
- C77.8 – Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions
- C77.9 – Secondary and unspecified malignant neoplasm of lymph node, unspecified
- C78.00 – Secondary and unspecified malignant neoplasm of unspecified lung
- C78.01 – Secondary malignant neoplasm of right lung
- C78.02 – Secondary malignant neoplasm of left lung
- C78.5 – Secondary malignant neoplasm of large intestine and rectum
- C78.6 – Secondary malignant neoplasm of retroperitoneum and peritoneum
- C78.7 – Secondary malignant neoplasm of liver and intrahepatic bile duct
- C79.00 – Secondary malignant neoplasm of unspecified kidney and renal pelvis
- C79.01 – Secondary malignant neoplasm of right kidney and renal pelvis
- C79.02 – Secondary malignant neoplasm of left kidney and renal pevis
- C79.2 – Secondary malignant neoplasm of skin
- C79.31 – Secondary malignant neoplasm of brain
- C79.51 – Secondary malignant neoplasm of bone
- C79.52 – Secondary malignant neoplasm of bone marrow
- C79.60 – Secondary malignant neoplasm of unspecified ovary
- C79.61 – Secondary malignant neoplasm of right ovary
- C79.62 – Secondary malignant neoplasm of left ovary
- C79.89 – Secondary malignant neoplasm of other specified sites
- C79.9 – Secondary malignant neoplasm of unspecified site
- C80.0 – Disseminated malignant neoplasm, unspecified
- C80.1 – Malignant (primary) neoplasm, unspecified
- C82.57 – Diffuse follicle center lymphoma, spleen
- C84.97 – Mature T/NK - cell lymphomas, unspecified, spleen
- C84.A7 – Cutaneous T - cell lymphoma, unspecified, spleen
- C85.17 – Unspecified B - cell lymphoma, spleen
- C85.27 – Mediastinal (thymic) large B - cell lymphoma, spleen
- C85.87 – Other specified types of non - Hodgkin lymphoma, spleen
- C85.97 – Non - Hodgkin lymphoma, unspecified spleen
- C86.1 – Hepatosplenic T - cell lymphoma
- D01.5 – Carcinoma in situ of liver, gallbladder and bile ducts
- D01.7 - Carcinoma in situ of other specified digestive oragans
- D01.9 - Carcinoma in situ of od digestive organ, unspecified
- D02.20 - Carcinoma in situ of unspecified bronchus and lung
- D02.21 – Carcinoma in situ of right bronchus and lung
- D02.22 - Carcinoma in situ of left bronchus and lung
- D03.51 - Melanoma in situ of anal skin
- D03.52 - Melanoma in situ of breast (skin) (soft tissue)
- D03.59 – Melanoma in situ of other part of trunk
- D49.0 – Neoplasm of unspecified behavior of digestive system
- D49.1 – Neoplasm of unspecified behavior of respiratory system
- D49.2 – Neoplasm of unspecified behavior of bone, soft tissue, and skin
- D49.3 – Neoplasm of unspecified behavior of breast
- D49.511-Neoplasm of unspecified behavior of right kidney
- D49.512-Neoplasm of unspecified behavior of left kidney
- D49.4 – Neoplasm of unspecified behavior of other genitourinary organs
- D49.6 – Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
- D49.89 – Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
- D49.9 – Neoplasm of unspecified behavior of unspecified sites
- J91.0 – Malignant pleural effusion
This test is to be ordered ONLY by the treating physician.