How To Use CPT Code 81203

CPT 81203 describes the analysis of the adenomatous polyposis coli (APC) gene for duplication/deletion variants. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81203?

CPT 81203 can be used to analyze the APC gene for duplication/deletion variants. This code is used when a lab analyst performs the technical lab test to identify specific changes involving repeated or deleted nucleotides in the APC gene. The test helps establish if the gene sequence shows a deletion (one or zero copies) or a duplication (three or more copies).

2. Official Description

The official description of CPT code 81203 is: ‘APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants.’

3. Procedure

1. The lab analyst performs technical steps to extract nucleic acids from the sample, such as cell lysis and digestion.
2. The lab analyst increases and stabilizes the quantity of nucleic acid for analysis by amplification.
3. The lab analyst detects the target genes by methods such as nucleic acid probes.
4. The lab analyst analyzes the APC gene for duplication/deletion variants, determining the number of copies of a specific gene sequence.

4. Qualifying circumstances

CPT 81203 is commonly ordered for patients with suspected familial adenomatosis polyposis (FAP) or suspected attenuated FAP. These conditions involve the formation of non-cancerous growths in the colon, called polyps, which often lead to colon cancer. The test helps identify duplication/deletion variants in the APC gene associated with these conditions.

5. When to use CPT code 81203

CPT code 81203 should be used when there is a clinical suspicion of FAP or attenuated FAP and the clinician wants to analyze the APC gene for duplication/deletion variants. This code is not limited to testing for these specific conditions but is commonly used in these cases.

6. Documentation requirements

To support a claim for CPT 81203, documentation should include:

• Clinical indication for the test, such as suspected FAP or attenuated FAP
• Details of the technical steps performed by the lab analyst
• Results of the analysis, indicating the presence or absence of duplication/deletion variants
• Interpretation and report by a physician if separately requested

7. Billing guidelines

When billing for CPT 81203, ensure that the test is performed by a lab analyst and that the documentation supports the clinical indication for the test. If a physician interpretation is separately requested and provided, it can be reported with modifier 26. Make sure to distinguish CPT 81203 from other APC gene analysis tests, such as CPT 81201 for the full APC gene sequence and CPT 81202 for APC familial variants.

8. Historical information

CPT 81203 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the analysis of the APC gene for duplication/deletion variants in a patient suspected of having FAP.
2. An oncologist ordering the analysis of the APC gene for duplication/deletion variants in a patient with a family history of colon cancer.
3. A genetic counselor requesting the analysis of the APC gene for duplication/deletion variants in a patient with multiple polyps in the colon.
4. A gastroenterologist ordering the analysis of the APC gene for duplication/deletion variants in a patient with suspected attenuated FAP.
5. A surgeon requesting the analysis of the APC gene for duplication/deletion variants in a patient scheduled for prophylactic colon surgery due to a family history of FAP.
6. A primary care physician ordering the analysis of the APC gene for duplication/deletion variants in a patient with unexplained gastrointestinal symptoms.
7. A pathologist interpreting the results of the analysis of the APC gene for duplication/deletion variants and providing a report to the ordering clinician.
8. A molecular geneticist performing the analysis of the APC gene for duplication/deletion variants in a research study on FAP.
9. A pediatrician ordering the analysis of the APC gene for duplication/deletion variants in a child with developmental delay and multiple congenital anomalies.
10. A geneticist requesting the analysis of the APC gene for duplication/deletion variants in a patient with a suspected genetic syndrome involving the APC gene.