How To Use CPT Code 81204

CPT 81204 describes the analysis of the androgen receptor (AR) gene to detect and characterize changes in the gene, such as expanded alleles or methylation status. 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 81204?

CPT 81204 can be used to analyze the androgen receptor (AR) gene to detect and characterize changes in the gene, such as expanded alleles or methylation status. This code is used when a lab analyst performs the technical lab test to identify abnormal nucleotide repeats or methylation status in the AR gene.

2. Official Description

The official description of CPT code 81204 is: ‘AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status)’

3. Procedure

1. The lab analyst performs the technical lab test to analyze the androgen receptor (AR) gene.
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 for analysis using techniques like polymerase chain reaction (PCR).
4. The lab analyst characterizes expanded alleles or methylation status in the AR gene.

4. Qualifying circumstances

CPT 81204 is used to detect and characterize expanded alleles or methylation status in the androgen receptor (AR) gene. While not limited to specific conditions, this test can aid in the diagnosis of genetic abnormalities associated with conditions such as spinal and bulbar muscular atrophy (SBMA), Kennedy disease, or X chromosome inactivation.

5. When to use CPT code 81204

CPT code 81204 should be used when there is a need to analyze the androgen receptor (AR) gene to detect and characterize expanded alleles or methylation status. It is important to note that this code is specific to the characterization of alleles and should not be confused with other codes that involve full gene sequence analysis or known familial variants.

6. Documentation requirements

To support a claim for CPT 81204, documentation should include:

• Indication of the need for AR gene analysis
• Details of the specimen used for testing
• Methods employed for nucleic acid extraction and amplification
• Results indicating the characterization of expanded alleles or methylation status
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81204, ensure that the test is performed by a lab analyst. It is important to distinguish this code from other codes related to the AR gene analysis. If the ordering clinician requests physician interpretation and the pathologist provides an interpretation and report, an additional code such as G0452 with modifier 26 may be reported. It is also important to consider payer-specific guidelines and requirements.

8. Historical information

CPT 81204 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs CPT 81204 to detect and characterize expanded alleles in the androgen receptor (AR) gene for a patient with spinal and bulbar muscular atrophy (SBMA).
2. CPT 81204 is used to analyze the androgen receptor (AR) gene and determine the methylation status for a patient with Kennedy disease.
3. A lab analyst performs CPT 81204 to detect and characterize expanded alleles in the androgen receptor (AR) gene for a patient with X chromosome inactivation.
4. CPT 81204 is used to analyze the androgen receptor (AR) gene and identify abnormal nucleotide repeats for a patient with a suspected genetic abnormality.
5. A lab analyst performs CPT 81204 to determine the methylation status of the androgen receptor (AR) gene for a patient with an undiagnosed neurodegenerative disorder.
6. CPT 81204 is used to analyze the androgen receptor (AR) gene and detect expanded alleles for a patient with a family history of genetic abnormalities.
7. A lab analyst performs CPT 81204 to characterize expanded alleles in the androgen receptor (AR) gene for a patient with symptoms of a genetic disorder.
8. CPT 81204 is used to analyze the androgen receptor (AR) gene and determine the methylation status for a patient with an X-linked recessive condition.
9. A lab analyst performs CPT 81204 to detect and characterize expanded alleles in the androgen receptor (AR) gene for a patient with a suspected genetic mutation.
10. CPT 81204 is used to analyze the androgen receptor (AR) gene and identify abnormal nucleotide repeats for a patient with a family history of neurodegenerative disorders.