How To Use CPT Code 81167

CPT 81167 describes the analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements. 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 81167?

CPT 81167 can be used to analyze the BRCA2 gene for full duplication/deletion, focusing on the detection of large gene rearrangements. This code is utilized when the lab analyst performs the technical lab test to examine the BRCA2 gene for any deletions or duplications that may indicate significant gene rearrangements.

2. Official Description

The official description of CPT code 81167 is: ‘BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements).’

3. Procedure

1. The lab analyst performs the technical lab test to analyze the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements.
2. The lab analyst extracts nucleic acids from a specimen, such as blood, using methods like cell lysis and digestion.
3. The lab analyst amplifies the nucleic acid quantity for analysis through processes like polymerase chain reaction (PCR).
4. A method such as Southern blot or multiplex ligation dependent probe amplification (MLPA) is performed to detect large duplications and deletions in the BRCA2 gene.
5. The lab analyst utilizes these techniques to identify any significant gene rearrangements that may be present.

4. Qualifying circumstances

CPT 81167 is typically ordered for patients with a family history of breast, ovarian, or certain other cancers, or for those who have already been diagnosed with these conditions. The analysis of the BRCA2 gene helps establish the patient’s hereditary status and assess their risk for developing these types of cancers. The gene is associated with various cancers, including breast, ovarian, prostate, pancreatic, fallopian tube, and melanoma.

5. When to use CPT code 81167

CPT code 81167 should be used when there is a need to analyze the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements. It is appropriate to bill this code when the lab analyst performs the technical lab test to examine the BRCA2 gene for any significant gene rearrangements. This code should not be used for other types of gene analysis or sequencing.

6. Documentation requirements

To support a claim for CPT 81167, the documentation should include:

• Indication of the patient’s family history or diagnosis that warrants the analysis of the BRCA2 gene
• Details of the technical lab test performed, including the methods used for nucleic acid extraction and amplification
• Description of the specific technique employed to detect large duplications and deletions in the BRCA2 gene
• Results of the analysis indicating the presence or absence of significant gene rearrangements
• Signature of the lab analyst who performed the analysis

7. Billing guidelines

When billing for CPT 81167, ensure that the analysis is performed for full duplication/deletion of the BRCA2 gene to detect large gene rearrangements. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. Additionally, consider reporting any separate services, such as specimen collection or interpretation by a physician, if applicable and supported by documentation.

8. Historical information

CPT 81167 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 lab analyst performing the technical lab test to analyze the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements in a patient with a family history of breast cancer.
2. An analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, performed by a lab analyst for a patient diagnosed with ovarian cancer.
3. A lab analyst examining the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, in a patient with a family history of multiple cancers.
4. An analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, conducted by a lab analyst for a patient with a family history of prostate cancer.
5. A lab analyst performing the technical lab test to analyze the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements in a patient with a family history of pancreatic cancer.
6. An analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, performed by a lab analyst for a patient with a family history of fallopian tube cancer.
7. A lab analyst examining the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, in a patient with a family history of melanoma.
8. An analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, conducted by a lab analyst for a patient with a family history of breast and ovarian cancer.
9. A lab analyst performing the technical lab test to analyze the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements in a patient with a family history of multiple cancers.
10. An analysis of the BRCA2 gene for full duplication/deletion, specifically detecting large gene rearrangements, performed by a lab analyst for a patient with a family history of prostate and pancreatic cancer.