How To Use CPT Code 81164

CPT 81164 describes the full duplication/deletion analysis of the BRCA1 and BRCA2 genes, which are associated with hereditary breast and ovarian cancer. 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 81164?

CPT 81164 can be used to analyze the BRCA1 and BRCA2 genes for full duplication and deletion. This test is performed to detect large gene rearrangements that may be associated with hereditary breast and ovarian cancer. It is important for clinicians to determine the hereditary status of patients with a family history or a diagnosis of breast, ovarian, or certain other cancers. The analysis of the BRCA1 and BRCA2 genes can provide valuable information in assessing the risk and guiding the management of these conditions.

2. Official Description

The official description of CPT code 81164 is: ‘BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements).’ This code is used specifically for the analysis of the BRCA1 and BRCA2 genes to identify full duplication and deletion events that may be present.

3. Procedure

1. The lab analyst performs the technical steps of the test, starting with the extraction of nucleic acids from a specimen such as blood.
2. The lab analyst then amplifies the nucleic acids using methods like polymerase chain reaction (PCR) to increase the quantity of genetic material for analysis.
3. A method such as Southern blot or multiplex ligation dependent probe amplification (MLPA) is used to detect large duplications and deletions in the BRCA1 and BRCA2 genes.
4. The lab analyst analyzes the results to identify any full duplication or deletion events in the genes.
5. A report is generated with the findings of the analysis, indicating the presence or absence of large gene rearrangements in the BRCA1 and BRCA2 genes.

4. Qualifying circumstances

CPT 81164 is typically ordered for patients with a family history or a diagnosis of breast, ovarian, or certain other cancers. The analysis of the BRCA1 and BRCA2 genes can help establish the hereditary status of these patients and guide their management. It is important to note that this test specifically focuses on the detection of full duplications and deletions in the genes, rather than other types of genetic variants or mutations.

5. When to use CPT code 81164

CPT code 81164 should be used when there is a clinical indication to analyze the BRCA1 and BRCA2 genes for full duplication and deletion events. This test is particularly relevant for patients with a family history or a diagnosis of breast, ovarian, or certain other cancers. It is important to consider the specific circumstances of each patient and consult with the ordering clinician to determine the appropriateness of using CPT code 81164.

6. Documentation requirements

To support a claim for CPT code 81164, the documentation should include:

• Clinical indication for the test, such as a family history or a diagnosis of breast, ovarian, or certain other cancers
• Details of the specimen used for analysis
• Methods employed for nucleic acid extraction and amplification
• Specific technique used for the detection of large gene rearrangements
• Results of the analysis, indicating the presence or absence of full duplications or deletions in the BRCA1 and BRCA2 genes
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 81164, it is important to ensure that the test is performed for the analysis of the BRCA1 and BRCA2 genes for full duplication and deletion. This code should not be reported in conjunction with other codes such as 81162, 81163, 81166, 81167, or 81217. It is also important to follow any specific billing guidelines provided by payers and to accurately report the necessary documentation to support the claim.

8. Historical information

CPT code 81164 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a family history of breast cancer undergoes CPT code 81164 to determine if there are any full duplications or deletions in the BRCA1 and BRCA2 genes.
2. A woman diagnosed with ovarian cancer undergoes CPT code 81164 to assess if there are any large gene rearrangements in the BRCA1 and BRCA2 genes.
3. A patient with a family history of multiple cancers undergoes CPT code 81164 to evaluate the presence of full duplications or deletions in the BRCA1 and BRCA2 genes.
4. A man with a family history of prostate cancer undergoes CPT code 81164 to determine if there are any large gene rearrangements in the BRCA1 and BRCA2 genes.
5. A woman with a family history of breast and ovarian cancer undergoes CPT code 81164 to assess the presence of full duplications or deletions in the BRCA1 and BRCA2 genes.