How To Use CPT Code 81221

CPT 81221 describes the genetic analysis procedure for detecting changes in the CFTR gene, specifically known familial variants. 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 81221?

CPT 81221 is used to analyze the CFTR gene for known familial variants. This genetic analysis procedure helps detect changes in the gene that may be associated with conditions such as cystic fibrosis. It specifically focuses on mutations that have been identified in the patient’s family members.

2. Official Description

The official description of CPT code 81221 is: ‘CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; known familial variants.’

3. Procedure

1. The lab analyst performs technical steps to analyze the CFTR gene, including extracting nucleic acids, amplifying the target genes, and detecting mutations using nucleic acid probes.

4. Qualifying circumstances

CPT 81221 is used when clinicians order the test for patients in families with known CFTR genetic mutations. It helps evaluate cystic fibrosis disease in the patient efficiently.

5. When to use CPT code 81221

CPT code 81221 should be used when analyzing the CFTR gene for known familial variants. It is not appropriate for analyzing common variants, duplication deletion variants, full gene sequence, or intron 8 poly-T analysis.

6. Documentation requirements

To support a claim for CPT 81221, documentation should include:

• Order for the test from the clinician
• Details of the specific known familial variants being analyzed
• Documentation of the technical steps performed by the lab analyst
• Interpretation of the results by an MD or DO physician, if separately requested

7. Billing guidelines

When billing for CPT 81221, ensure that the test is performed for known familial variants of the CFTR gene. It should not be reported with other codes for different variants or gene analyses. If the pathologist provides an interpretation and report, you may additionally report G0452 with modifier 26 to Medicare and other payers.

8. Historical information

CPT 81221 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 CPT 81221 to analyze the CFTR gene for known familial variants in a patient with a family history of cystic fibrosis.
2. A clinician ordering CPT 81221 to evaluate the presence of specific mutations in the CFTR gene for a patient from a family with known genetic variants.
3. A lab technician conducting CPT 81221 to detect changes in the CFTR gene associated with cystic fibrosis in a patient with a family history of the condition.
4. A physician interpreting the results of CPT 81221 to confirm the presence of known familial variants in the CFTR gene for a patient with suspected cystic fibrosis.
5. A genetic counselor recommending CPT 81221 to assess the risk of cystic fibrosis in a patient based on their family history and known CFTR gene mutations.
6. A pathologist providing an interpretation and report for CPT 81221 to assist in the diagnosis and management of cystic fibrosis in a patient with known familial variants in the CFTR gene.
7. A molecular biologist performing CPT 81221 to analyze the CFTR gene for specific mutations in a patient with a family history of cystic fibrosis.
8. A geneticist ordering CPT 81221 to evaluate the presence of known familial variants in the CFTR gene for a patient with symptoms suggestive of cystic fibrosis.
9. A laboratory scientist conducting CPT 81221 to detect changes in the CFTR gene associated with cystic fibrosis in a patient with a family history of the condition.
10. A clinician using the results of CPT 81221 to guide the management and treatment decisions for a patient with confirmed familial variants in the CFTR gene.