How To Use CPT Code 81109

CPT 81109 describes the genetic analysis procedure known as Human Platelet Antigen 5 genotyping (HPA-5). This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81109?

CPT 81109 is a code used to describe the genetic analysis procedure called Human Platelet Antigen 5 genotyping (HPA-5). This test analyzes the genes of the two common alleles of HPA-5, also known as K505E, using a specimen such as blood or amniotic fluid. It is commonly ordered by clinicians to assess risk or aid in the diagnosis of conditions such as neonatal alloimmune thrombocytopenia (NAIT), post-transfusion purpura (PTP), and thrombocytopenia.

2. Official Description

The official description of CPT code 81109 is: ‘Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b [K505E]).’

3. Procedure

1. The lab analyst performs the technical lab test to analyze the genes of the two common alleles of Human Platelet Antigen 5 (HPA–5), also called K505E, using a specimen such as blood or amniotic fluid.
2. The lab analyst performs all technical steps, from extracting the nucleic acids to detecting the target genes, using methods such as polymerase chain reaction (PCR) for multiple alleles and fluorescence or other markers to identify HPA–5 antigen alleles in the patient specimen.
3. The lab analyst uses a specimen such as blood or amniotic fluid to identify patient HPA–5 antigen genotype for fetuses or neonates with suspected NAIT, or for parents or prospective parents who have had an affected pregnancy to assess pregnancy risk, or for patients exhibiting PTP to aid in the diagnosis of a potential transfusion reaction.

4. Qualifying circumstances

CPT 81109 is commonly ordered by clinicians to assess risk or aid in the diagnosis of conditions such as neonatal alloimmune thrombocytopenia (NAIT), post-transfusion purpura (PTP), and thrombocytopenia. The test helps identify patient HPA–5 antigen genotype for fetuses or neonates with suspected NAIT, or for parents or prospective parents who have had an affected pregnancy to assess pregnancy risk, or for patients exhibiting PTP to aid in the diagnosis of a potential transfusion reaction.

5. When to use CPT code 81109

CPT code 81109 should be used when a clinician orders the genetic analysis procedure for Human Platelet Antigen 5 genotyping (HPA-5) to assess risk or aid in the diagnosis of conditions such as neonatal alloimmune thrombocytopenia (NAIT), post-transfusion purpura (PTP), and thrombocytopenia. It is important to ensure that the test is medically necessary and ordered by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT code 81109, the documentation should include:

• Patient’s clinical history and reason for ordering the test
• Details of the genetic analysis procedure performed, including the methods used and the specimen analyzed
• Results of the analysis, including the patient’s HPA–5 antigen genotype
• Interpretation of the results, if applicable
• Signature of the healthcare professional ordering the test

7. Billing guidelines

When billing for CPT code 81109, ensure that the test is medically necessary and ordered by a qualified healthcare professional. It is important to follow the specific guidelines provided by the payer regarding documentation and coding requirements. Additionally, be aware of any specific modifiers or additional codes that may be required for accurate billing.

8. Historical information

CPT code 81109 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders CPT code 81109 to assess the risk of neonatal alloimmune thrombocytopenia (NAIT) in a pregnant patient with a history of affected pregnancies.
2. A patient with post-transfusion purpura (PTP) undergoes CPT code 81109 to aid in the diagnosis of a potential transfusion reaction.
3. A clinician orders CPT code 81109 to assess the risk of thrombocytopenia in a patient with unexplained low platelet count.
4. A couple planning to have a child undergoes CPT code 81109 to assess the risk of neonatal alloimmune thrombocytopenia (NAIT) based on their HPA–5 antigen genotypes.
5. A clinician orders CPT code 81109 to aid in the diagnosis of a potential transfusion reaction in a patient who recently received a blood transfusion.
6. A pregnant patient with a history of neonatal alloimmune thrombocytopenia (NAIT) undergoes CPT code 81109 to assess the risk of recurrence in the current pregnancy.
7. A patient with unexplained purpura undergoes CPT code 81109 to aid in the diagnosis of the underlying cause.
8. A clinician orders CPT code 81109 to assess the risk of thrombocytopenia in a patient with a family history of the condition.
9. A patient with a history of transfusion reactions undergoes CPT code 81109 to aid in the diagnosis of a potential transfusion reaction.