How To Use CPT Code 81209

CPT 81209 describes the genetic analysis procedure for detecting common changes in the BLM gene, also known as Bloom syndrome, RecQ helicase-like. 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 81209?

CPT 81209 can be used to describe the genetic analysis procedure for detecting common changes in the BLM gene, which is associated with Bloom syndrome, RecQ helicase-like. This code is used when the lab analyst performs the technical steps to identify common variants in the BLM gene, including the specific variant 2281del6ins7.

2. Official Description

The official description of CPT code 81209 is: ‘BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) gene analysis, 2281del6ins7 variant.’

3. Procedure

1. The lab analyst performs the technical steps of the genetic analysis procedure to detect common changes in the BLM gene.
2. This includes extracting nucleic acids, amplifying the quantity of nucleic acid for analysis, and detecting the target genes using nucleic acid probes.
3. The procedure may also include testing for other non-listed variants in addition to the 2281del6ins7 variant.

4. Qualifying circumstances

CPT 81209 is commonly ordered for patients suspected of having Bloom syndrome, especially among those of Central and Eastern European Ashkenazi Jewish descent. However, it is not limited to testing for a specific condition. The procedure is performed to identify common variants in the BLM gene, which may cause genetic disorders or cancer.

5. When to use CPT code 81209

CPT code 81209 should be used when a genetic analysis procedure is performed to detect common changes in the BLM gene, specifically the 2281del6ins7 variant. It is important to note that this code is not limited to a specific condition and can be used for patients suspected of having Bloom syndrome or other genetic disorders.

6. Documentation requirements

To support a claim for CPT 81209, documentation should include:

• Reason for ordering the genetic analysis procedure
• Specific variant being tested for, including the 2281del6ins7 variant
• Date and time of the procedure
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including any other non-listed variants detected
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81209, ensure that the procedure is performed to detect common changes in the BLM gene, specifically the 2281del6ins7 variant. It is important to follow any additional guidelines provided by payers regarding the reporting of this code. If the ordering clinician separately requests physician interpretation of the test, it may be appropriate to report an additional code, such as G0452 with modifier 26, for the interpretation performed by an M.D. or D.O physician.

8. Historical information

CPT 81209 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 genetic analysis procedure to detect common changes in the BLM gene for a patient suspected of having Bloom syndrome.
2. A geneticist ordering a genetic analysis procedure to identify the 2281del6ins7 variant in the BLM gene for a patient with a family history of genetic disorders.
3. A pathologist interpreting the results of a genetic analysis procedure for a patient with suspected Bloom syndrome and providing a report on the detected variants.
4. A lab technician performing the technical steps of a genetic analysis procedure to detect common changes in the BLM gene for a patient undergoing cancer genetic testing.
5. A molecular biologist conducting a genetic analysis procedure to identify the 2281del6ins7 variant in the BLM gene for research purposes.
6. A genetic counselor ordering a genetic analysis procedure to detect common changes in the BLM gene for a patient with unexplained symptoms and suspected genetic abnormalities.
7. A lab scientist performing a genetic analysis procedure to identify the 2281del6ins7 variant in the BLM gene for a patient participating in a clinical trial for a new treatment.
8. A pathologist reviewing the results of a genetic analysis procedure for a patient with a suspected genetic disorder and providing recommendations for further testing or treatment.
9. A lab analyst conducting a genetic analysis procedure to detect common changes in the BLM gene for a patient undergoing preconception genetic screening.
10. A geneticist ordering a genetic analysis procedure to identify the 2281del6ins7 variant in the BLM gene for a patient with a known family history of Bloom syndrome.