How To Use CPT Code 81223

CPT 81223 describes the analysis of the full gene sequence for the cystic fibrosis transmembrane conductance regulator (CFTR) gene. 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 81223?

CPT 81223 is used to analyze the entire gene sequence of the CFTR gene, also known as the cystic fibrosis transmembrane conductance regulator gene. This code is specifically used to identify any variations or mutations in the gene that may be associated with cystic fibrosis.

2. Official Description

The official description of CPT code 81223 is: ‘CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; full gene sequence.’

3. Procedure

1. The lab analyst performs technical steps to extract nucleic acids from the sample, such as cell lysis and digestion.
2. The lab analyst amplifies and stabilizes the quantity of nucleic acid for analysis by methods like polymerase chain reaction (PCR) or transcription of DNA to RNA and reverse transcription from RNA to make an additional copy of the DNA.
3. The lab analyst detects the target genes by methods such as nucleic acid probes to analyze the full gene sequence of CFTR.

4. Qualifying circumstances

CPT 81223 is typically ordered for patients who are already diagnosed with cystic fibrosis, those with a family history of the condition, or symptomatic individuals with negative screening results. It may also be ordered for males with a congenital abnormality associated with CFTR mutations involving the absence of the vas deferens.

5. When to use CPT code 81223

CPT code 81223 should be used when there is a need to analyze the full gene sequence of CFTR, rather than just common variations in the gene. It is important to distinguish this code from other codes that may be used for specific variants or intron analysis of CFTR.

6. Documentation requirements

To support a claim for CPT 81223, documentation should include:

• Indication for the analysis of the full gene sequence of CFTR
• Details of the technical steps performed, such as cell lysis, amplification, and detection methods
• Date and time of the analysis
• Results of the analysis, including any identified variations or mutations
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81223, ensure that the analysis includes the full gene sequence of CFTR. It is important to distinguish this code from other codes that may be used for specific variants or intron analysis of CFTR. If there is a separate request for physician interpretation, it may be appropriate to report an additional code with modifier 26.

8. Historical information

CPT 81223 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 patient with a family history of cystic fibrosis undergoes CPT 81223 to analyze the full gene sequence of CFTR.
2. An individual who has been diagnosed with cystic fibrosis undergoes CPT 81223 to identify any variations or mutations in the CFTR gene.
3. A male with a congenital abnormality associated with CFTR mutations involving the absence of the vas deferens undergoes CPT 81223 to analyze the full gene sequence of CFTR.
4. A symptomatic individual with negative screening results undergoes CPT 81223 to identify any variations or mutations in the CFTR gene.
5. A patient with suspected cystic fibrosis undergoes CPT 81223 to analyze the full gene sequence of CFTR.