How To Use CPT Code 81208

CPT 81208 describes the analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints due to translocation. 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 81208?

CPT 81208 can be used to analyze BCR/ABL1 gene sequences that occur on chromosome 22 at breakpoints other than the major and minor breakpoints due to translocation. This code is used for qualitative or quantitative testing to identify the presence of BCR/ABL1 fusion genes associated with these other breakpoints.

2. Official Description

The official description of CPT code 81208 is: ‘BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative.’

3. Procedure

1. The lab analyst performs technical steps to evaluate BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints.
2. The lab analyst may perform qualitative analysis to identify the presence of BCR/ABL1 fusion genes or quantitative analysis to measure the amount of fusion genes present.
3. The lab analyst extracts nucleic acids, amplifies the quantity of nucleic acid for analysis, detects the target DNA sequence, and measures the relative quantity of the target gene sequences.

4. Qualifying circumstances

CPT 81208 is used when analyzing BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints due to translocation. This test is often ordered to help diagnose and evaluate treatment for chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL) in certain subsets of patients.

5. When to use CPT code 81208

CPT code 81208 should be used when performing qualitative or quantitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints due to translocation. This code is appropriate when evaluating patients with suspected or diagnosed chronic myelogenous leukemia (CML) or acute lymphoblastic leukemia (ALL) in certain subsets.

6. Documentation requirements

To support a claim for CPT 81208, the following documentation is required:

• Indication for the test and the specific condition being evaluated
• Details of the technical steps performed, including nucleic acid extraction, amplification, target DNA sequence detection, and measurement of relative quantity of target gene sequences
• Results of the qualitative or quantitative analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81208, ensure that the analysis is performed for BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints due to translocation. This code should not be reported with other codes unless specifically requested by the ordering clinician for physician interpretation. In such cases, modifier 26 should be appended to CPT 81208. It is important to note that the interpretation must be performed by an M.D. or D.O physician, not a PhD laboratory scientist.

8. Historical information

CPT 81208 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 performs qualitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints for a patient suspected of having chronic myelogenous leukemia (CML).
2. A lab analyst performs quantitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints for a patient diagnosed with acute lymphoblastic leukemia (ALL).
3. A lab analyst analyzes BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, providing both qualitative and quantitative results for a patient with suspected genetic abnormalities.
4. A lab analyst performs qualitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, confirming the presence of fusion genes in a patient with a suspected translocation abnormality.
5. A lab analyst performs quantitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, measuring the relative quantity of fusion genes in a patient with a known translocation abnormality.
6. A lab analyst analyzes BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, providing a comprehensive report on the presence and quantity of fusion genes for a patient undergoing treatment for leukemia.
7. A lab analyst performs qualitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, confirming the absence of fusion genes in a patient with suspected leukemia.
8. A lab analyst performs quantitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, measuring the relative quantity of fusion genes in a patient with a suspected translocation abnormality.
9. A lab analyst analyzes BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, providing both qualitative and quantitative results for a patient with a known translocation abnormality.
10. A lab analyst performs qualitative analysis of BCR/ABL1 gene sequences associated with breakpoints other than the major and minor breakpoints, confirming the presence of fusion genes in a patient with a suspected genetic abnormality.