How To Use CPT Code 81200

CPT 81200 describes the analysis of the ASPA gene for common variants, such as E285A and Y231X. 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 81200?

CPT 81200 is used to analyze the ASPA gene for common variants, specifically E285A and Y231X. This test is performed by a lab analyst to detect the presence of these variants in the gene. It is commonly ordered for patients suspected of having Canavan disease, a genetic disorder characterized by progressive brain nerve-cell damage.

2. Official Description

The official description of CPT code 81200 is: ‘ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)’

3. Procedure

1. The lab analyst performs all technical steps of the test, including extracting nucleic acids, amplifying the quantity of nucleic acid for analysis, and detecting the target genes using nucleic acid probes.

4. Qualifying circumstances

CPT 81200 is typically ordered for patients suspected of having Canavan disease, a genetic disorder caused by certain mutations in the ASPA gene. These mutations interfere with the production of aspartoacylase, an enzyme that breaks down N-acetyl-L-aspartic acid and affects the production of myelin, a protective coating for nerve cells.

5. When to use CPT code 81200

CPT code 81200 should be used when analyzing the ASPA gene for common variants, such as E285A and Y231X. It is appropriate to use this code when there is a clinical suspicion of Canavan disease or when the ordering clinician believes that testing for these variants is necessary.

6. Documentation requirements

To support a claim for CPT 81200, the documentation should include:

• Reason for ordering the test, such as suspicion of Canavan disease
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including the presence or absence of the common variants
• Interpretation of the test results, if provided by a physician

7. Billing guidelines

When billing for CPT 81200, ensure that the test is performed by a lab analyst and that the analysis includes the detection of common variants in the ASPA gene. It is important to follow any specific guidelines provided by payers regarding the reporting of this code. If a physician provides an interpretation of the test results, it may be appropriate to report an additional code, such as G0452 with modifier 26.

8. Historical information

CPT 81200 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the analysis of the ASPA gene for common variants E285A and Y231X in a patient suspected of having Canavan disease.
2. An ordering clinician requesting CPT 81200 to confirm the presence of common variants in the ASPA gene for a patient with symptoms consistent with Canavan disease.
3. A lab analyst analyzing the ASPA gene for common variants in a newborn with a family history of Canavan disease.
4. A physician interpreting the results of CPT 81200 and providing a report for a patient suspected of having Canavan disease.
5. A lab analyst performing the analysis of the ASPA gene for common variants in a research study on Canavan disease.
6. An ordering clinician requesting CPT 81200 to rule out the presence of common variants in the ASPA gene for a patient with symptoms unrelated to Canavan disease.
7. A lab analyst analyzing the ASPA gene for common variants in a patient with a family history of neurological disorders.
8. A physician ordering CPT 81200 to confirm the absence of common variants in the ASPA gene for a patient with symptoms similar to Canavan disease.
9. A lab analyst performing the analysis of the ASPA gene for common variants in a patient with an atypical presentation of Canavan disease.
10. An ordering clinician requesting CPT 81200 to determine the presence of common variants in the ASPA gene for a patient with developmental delays.