How To Use CPT Code 81168

CPT 81168 describes the major breakpoint translocation analysis for CCND1/IGH (t(11;14)), which is associated with mantle cell lymphoma (MCL). 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 81168?

CPT 81168 can be used to describe the major breakpoint translocation analysis for CCND1/IGH (t(11;14)), which is a genetic abnormality associated with mantle cell lymphoma (MCL). This code is used when a lab analyst performs the technical lab test on a specimen, such as blood, formalin-fixed paraffin-embedded tissue (FFPE), or bone marrow, to evaluate the major breakpoint for CCND1/IGH (t(11;14)). The analysis can be qualitative, identifying the presence of the fusion gene, or quantitative, using methods like real-time PCR to detect CCND1/IGH (t(11;14)) rearrangements.

2. Official Description

The official description of CPT code 81168 is: ‘CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed.’

3. Procedure

1. The lab analyst performs the technical lab test on a specimen, such as blood, FFPE tissue, or bone marrow.
2. The nucleic acids are extracted from the specimen using methods like cell lysis and digestion.
3. The quantity of nucleic acid is increased and stabilized for analysis through amplification techniques like PCR.
4. The target genes, specifically the major breakpoint for CCND1/IGH (t(11;14)), are detected using methods like real-time PCR.

4. Qualifying circumstances

CPT 81168 is used when clinicians order the major breakpoint translocation analysis for CCND1/IGH (t(11;14)) to confirm the diagnosis of mantle cell lymphoma (MCL), monitor therapy efficacy, or detect residual disease. The major breakpoint for CCND1/IGH (t(11;14)) is characteristic of MCL, a rare form of B-cell non-Hodgkin lymphoma. The analysis is performed by a lab analyst on specimens like blood, FFPE tissue, or bone marrow.

5. When to use CPT code 81168

CPT code 81168 should be used when a lab analyst performs the major breakpoint translocation analysis for CCND1/IGH (t(11;14)) on a specimen, such as blood, FFPE tissue, or bone marrow. It is appropriate to bill this code when the analysis is qualitative, identifying the presence of the fusion gene, or quantitative, using methods like real-time PCR to detect CCND1/IGH (t(11;14)) rearrangements.

6. Documentation requirements

To support a claim for CPT 81168, the documentation should include:

• Order for the major breakpoint translocation analysis for CCND1/IGH (t(11;14)) from the clinician
• Specimen type used for the analysis (blood, FFPE tissue, or bone marrow)
• Method used for nucleic acid extraction
• Amplification technique used for increasing and stabilizing the quantity of nucleic acid
• Method used for detecting the major breakpoint for CCND1/IGH (t(11;14)) (qualitative or quantitative)
• Results of the analysis
• Interpretation of the results, if performed by a physician

7. Billing guidelines

When billing for CPT 81168, ensure that the major breakpoint translocation analysis for CCND1/IGH (t(11;14)) is performed by a lab analyst on a specimen like blood, FFPE tissue, or bone marrow. It is important to specify whether the analysis is qualitative or quantitative. Additionally, consider reporting separate codes for specimen collection or processing, if applicable. If a physician provides interpretation of the test results, it may be appropriate to report an additional code with modifier 26.

8. Historical information

CPT 81168 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the major breakpoint translocation analysis for CCND1/IGH (t(11;14)) on a blood specimen to confirm the diagnosis of mantle cell lymphoma (MCL).
2. The major breakpoint translocation analysis for CCND1/IGH (t(11;14)) is performed on a bone marrow specimen to monitor the efficacy of therapy in a patient with MCL.
3. A lab analyst uses real-time PCR to quantitatively detect CCND1/IGH (t(11;14)) rearrangements in a formalin-fixed paraffin-embedded tissue specimen from a patient with suspected MCL.
4. The major breakpoint translocation analysis for CCND1/IGH (t(11;14)) is performed on a blood specimen to detect residual disease in a patient previously treated for MCL.
5. A lab analyst performs the qualitative major breakpoint translocation analysis for CCND1/IGH (t(11;14)) on a bone marrow specimen to confirm the diagnosis of MCL in a patient with lymphadenopathy and other clinical symptoms.
6. The major breakpoint translocation analysis for CCND1/IGH (t(11;14)) is performed on a formalin-fixed paraffin-embedded tissue specimen to monitor the response to therapy in a patient with MCL.
7. A lab analyst uses real-time PCR to quantitatively detect CCND1/IGH (t(11;14)) rearrangements in a blood specimen from a patient with MCL to assess the disease burden.