How To Use CPT Code 81163

CPT 81163 describes the full sequence analysis of the BRCA1 and BRCA2 genes, which are associated with hereditary breast and ovarian cancer. 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 81163?

CPT 81163 can be used to analyze the entire gene sequence of the BRCA1 and BRCA2 genes, which are involved in DNA repair and associated with hereditary breast and ovarian cancer. This code is used when a lab analyst performs the technical steps to extract nucleic acids, amplify the DNA, and detect the target genes for analysis.

2. Official Description

The official description of CPT code 81163 is: ‘BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis.’

3. Procedure

1. The lab analyst extracts nucleic acids from a specimen, such as blood, using methods like cell lysis and digestion.
2. The quantity of nucleic acid is increased and stabilized for analysis through amplification techniques like polymerase chain reaction (PCR).
3. The lab analyst analyzes the full gene sequences of BRCA1 and BRCA2 to detect any variants or mutations.

4. Qualifying circumstances

CPT 81163 is ordered for patients with a family history or diagnosis of breast, ovarian, or certain other cancers to determine their hereditary status. The BRCA1 and BRCA2 genes are tumor suppressor genes, and changes in these genes are associated with various cancers. The test must be performed by a lab analyst and involves the full sequence analysis of both genes.

5. When to use CPT code 81163

CPT code 81163 should be used when a clinician orders the full sequence analysis of the BRCA1 and BRCA2 genes to assess a patient’s hereditary risk for breast, ovarian, or other associated cancers. This code is not limited to testing for a specific condition but is used to establish the patient’s hereditary status.

6. Documentation requirements

To support a claim for CPT 81163, the documentation should include:

• Reason for ordering the test, such as family history or cancer diagnosis
• Details of the technical steps performed by the lab analyst
• Date and time of the analysis
• Results of the full sequence analysis of the BRCA1 and BRCA2 genes
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81163, ensure that the test is performed by a lab analyst and involves the full sequence analysis of both the BRCA1 and BRCA2 genes. It is important to distinguish this code from other codes related to the BRCA genes, such as those for duplication/deletion analysis or common-variant analysis. Additional codes may be reported for specimen collection or interpretation of the test results, if applicable.

8. Historical information

CPT 81163 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient with a family history of breast cancer undergoes CPT 81163 to determine their hereditary risk for developing the disease.
2. A woman diagnosed with ovarian cancer undergoes CPT 81163 to assess her hereditary risk for other associated cancers.
3. A patient with a family history of multiple cancers undergoes CPT 81163 to evaluate their overall hereditary risk.
4. A man with a family history of prostate cancer undergoes CPT 81163 to determine his hereditary risk for other associated cancers.
5. A patient with a family history of melanoma undergoes CPT 81163 to assess their hereditary risk for other types of cancer.
6. A woman diagnosed with fallopian tube cancer undergoes CPT 81163 to evaluate her hereditary risk for other associated cancers.
7. A patient with a family history of pancreatic cancer undergoes CPT 81163 to determine their hereditary risk for developing the disease.
8. A man diagnosed with breast cancer undergoes CPT 81163 to assess his hereditary risk for other associated cancers.
9. A woman with a family history of breast and ovarian cancer undergoes CPT 81163 to evaluate her hereditary risk for other types of cancer.
10. A patient with a family history of breast cancer and prostate cancer undergoes CPT 81163 to determine their hereditary risk for developing these diseases.