How To Use CPT Code 81161

CPT 81161 describes the analysis of specific changes in the dystrophin gene, also known as the DMD gene, for conditions such as Duchenne and Becker muscular dystrophy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81161?

CPT 81161 can be used to describe the analysis of specific changes in the dystrophin gene, including deletions and duplications, if performed. This code is used when a lab analyst performs the technical steps involved in analyzing the nucleotide sequences of the DMD gene to identify disease-associated deletions or duplications.

2. Official Description

The official description of CPT code 81161 is: ‘DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed.’

3. Procedure

1. The lab analyst performs technical steps to extract nucleic acids from the sample, such as cell lysis and digestion.
2. The lab analyst amplifies and stabilizes the quantity of nucleic acid for analysis by methods like polymerase chain reaction (PCR) or transcription of DNA to RNA and reverse transcription from RNA to make an additional copy of the DNA.
3. Nucleic acid probes are used to analyze the DMD gene for specific disease-associated deletions and duplications.
4. The lab analyst detects the target genes using methods such as nucleic acid probes.

4. Qualifying circumstances

CPT 81161 is typically ordered in association with conditions like Duchenne and Becker muscular dystrophy. It is used to confirm a clinical diagnosis of the disease or to identify carrier status in mothers with a family history of the disease. The test evaluates deletions that account for approximately 65 percent of mutations in patients with DMD or BMD.

5. When to use CPT code 81161

CPT code 81161 should be used when a lab analyst performs the analysis of specific changes in the dystrophin gene, including deletions and duplications. It is appropriate to bill this code when the analysis is performed for conditions like Duchenne and Becker muscular dystrophy.

6. Documentation requirements

To support a claim for CPT 81161, the documentation should include:

• Reason for ordering the test and the specific condition being evaluated
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including any identified deletions or duplications
• Interpretation of the test results, if separately requested by the ordering clinician

7. Billing guidelines

When billing for CPT 81161, ensure that the analysis is performed by a lab analyst. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. If the ordering clinician requests a separate interpretation of the test results, it may be appropriate to report an additional code, such as G0452 with modifier 26, if performed by an MD or DO physician.

8. Historical information

CPT 81161 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the analysis of specific changes in the dystrophin gene to identify disease-associated deletions in a patient with Duchenne muscular dystrophy.
2. The analysis of specific changes in the dystrophin gene is performed by a lab analyst to confirm a clinical diagnosis of Becker muscular dystrophy in a patient.
3. A lab analyst analyzes the nucleotide sequences of the DMD gene to identify duplications in a mother with a family history of Duchenne muscular dystrophy to determine carrier status.
4. The analysis of specific changes in the dystrophin gene is performed by a lab analyst to evaluate deletions in a patient suspected of having Becker muscular dystrophy.
5. A lab analyst performs the analysis of specific changes in the dystrophin gene to identify disease-associated deletions in a patient with an undiagnosed muscular dystrophy.
6. The analysis of specific changes in the dystrophin gene is performed by a lab analyst to confirm a clinical diagnosis of Duchenne muscular dystrophy in a patient with characteristic symptoms.
7. A lab analyst analyzes the nucleotide sequences of the DMD gene to identify duplications in a patient with Becker muscular dystrophy to determine the extent of the genetic mutation.
8. The analysis of specific changes in the dystrophin gene is performed by a lab analyst to evaluate deletions in a patient with a family history of Duchenne muscular dystrophy.
9. A lab analyst performs the analysis of specific changes in the dystrophin gene to identify disease-associated deletions in a patient with a suspected genetic disorder affecting muscle function.
10. The analysis of specific changes in the dystrophin gene is performed by a lab analyst to confirm a clinical diagnosis of Becker muscular dystrophy in a patient with progressive muscle weakness.