How To Use CPT Code 81206

CPT 81206 describes the analysis of the BCR/ABL1 (t(9;22)) translocation, specifically the major breakpoint gene sequence, which is associated with chronic myelogenous leukemia. 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 81206?

CPT 81206 is used to analyze the BCR/ABL1 (t(9;22)) translocation, specifically the major breakpoint gene sequence. This translocation is associated with chronic myelogenous leukemia (CML). The test can be qualitative, identifying the presence of the BCR/ABL1 fusion gene associated with the major breakpoint, or quantitative, measuring the amount of each fusion gene present.

2. Official Description

The official description of CPT code 81206 is: ‘BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative.’

3. Procedure

1. The lab analyst performs the technical lab test to evaluate the major breakpoint gene sequence BCR/ABL1 that occurs on chromosome 22 due to translocation.
2. The test can be qualitative, identifying the presence of the BCR/ABL1 fusion gene associated with the major breakpoint, or quantitative, measuring the amount of each fusion gene present.
3. The lab analyst performs all technical steps, including extracting nucleic acids, amplifying and stabilizing the quantity of nucleic acid for analysis, detecting the target DNA sequence, and measuring the relative quantity of the target gene sequences.

4. Qualifying circumstances

CPT 81206 is typically ordered to help diagnose chronic myelogenous leukemia (CML) because almost all CML cases involve major breakpoint BCR/ABL1 fusion genes. However, it is not limited to testing for CML and can be used to analyze the major breakpoint gene sequence associated with other conditions.

5. When to use CPT code 81206

CPT code 81206 should be used when analyzing the major breakpoint gene sequence BCR/ABL1 associated with chronic myelogenous leukemia (CML) or other relevant conditions. It is important to determine whether a qualitative or quantitative analysis is required based on the specific clinical scenario.

6. Documentation requirements

To support a claim for CPT 81206, the documentation should include:

• Indication for the test and the specific condition being evaluated
• Whether the analysis is qualitative or quantitative
• Date and time of the test
• Results of the analysis, including the presence or absence of the BCR/ABL1 fusion gene and the relative quantity if applicable
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81206, ensure that the analysis is performed by a qualified lab analyst. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. Additionally, if the ordering clinician separately requests physician interpretation of the test, it may be appropriate to report an additional code for the interpretation.

8. Historical information

CPT 81206 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 a qualitative analysis of the major breakpoint gene sequence BCR/ABL1 for a patient suspected of having chronic myelogenous leukemia.
2. An oncologist ordering a quantitative analysis of the major breakpoint gene sequence BCR/ABL1 to monitor the response to treatment in a patient with chronic myelogenous leukemia.
3. A hematologist requesting a qualitative analysis of the major breakpoint gene sequence BCR/ABL1 to confirm the diagnosis of chronic myelogenous leukemia in a patient with suspicious blood test results.
4. A pathologist interpreting the results of a qualitative analysis of the major breakpoint gene sequence BCR/ABL1 and providing a report for a patient with suspected chronic myelogenous leukemia.
5. A genetic counselor discussing the implications of a positive qualitative analysis of the major breakpoint gene sequence BCR/ABL1 with a patient and their family.
6. A researcher using a quantitative analysis of the major breakpoint gene sequence BCR/ABL1 to study the progression of chronic myelogenous leukemia in a laboratory setting.
7. A physician ordering a qualitative analysis of the major breakpoint gene sequence BCR/ABL1 to rule out chronic myelogenous leukemia in a patient with concerning symptoms.
8. A lab analyst performing a quantitative analysis of the major breakpoint gene sequence BCR/ABL1 to assess the response to targeted therapy in a patient with chronic myelogenous leukemia.
9. An oncology nurse explaining the purpose and process of a qualitative analysis of the major breakpoint gene sequence BCR/ABL1 to a patient scheduled for the test.
10. A hematopathologist reviewing the results of a quantitative analysis of the major breakpoint gene sequence BCR/ABL1 and providing recommendations for further treatment in a patient with chronic myelogenous leukemia.