How To Use CPT Code 81234

CPT 81234 describes the analysis of the DM1 protein kinase (DMPK) gene to detect abnormal alleles, typically associated with myotonic dystrophy type 1 (DM1). 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 81234?

CPT 81234 is used to analyze the DM1 protein kinase (DMPK) gene to detect abnormal alleles. This test is typically ordered to aid in the diagnosis of myotonic dystrophy type 1 (DM1), a type of muscular dystrophy characterized by muscle wasting, cardiac complications, and problems with voluntary muscle control. The test involves analyzing the DMPK gene for expanded sequences of the nucleotide sequence CTG, which are indicative of abnormal alleles.

2. Official Description

The official description of CPT code 81234 is: ‘DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles.’

3. Procedure

1. The lab analyst performs technical steps to analyze the DMPK gene, using a specimen such as blood.
2. The nucleic acids are extracted from the specimen through methods like cell lysis and digestion.
3. The quantity of nucleic acid is increased and stabilized for analysis through amplification using techniques like polymerase chain reaction (PCR).
4. The lab analyst detects the presence of abnormal alleles in the DMPK gene.

4. Qualifying circumstances

CPT 81234 is typically ordered when there is a suspicion of myotonic dystrophy type 1 (DM1) or a need to determine carrier status. The test is not limited to DM1 and can be used to detect abnormal alleles in the DMPK gene for other purposes as well. The presence of expanded sequences of the nucleotide sequence CTG in the DMPK gene indicates the presence of abnormal alleles.

5. When to use CPT code 81234

CPT code 81234 should be used when there is a need to analyze the DMPK gene for the detection of abnormal alleles, typically associated with myotonic dystrophy type 1 (DM1). It is important to ensure that the test is performed using only one assay, typically polymerase chain reaction (PCR), and does not include characterization of the expanded alleles.

6. Documentation requirements

To support a claim for CPT 81234, the documentation should include:

• Reason for ordering the test, such as suspicion of myotonic dystrophy type 1 (DM1)
• Details of the technical steps performed during the analysis
• Results of the analysis, including the presence or absence of abnormal alleles
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81234, ensure that the test is performed to analyze the DMPK gene for the detection of abnormal alleles. It is important to distinguish CPT 81234 from related codes, such as CPT 81239, which characterizes the expanded alleles if found. Additionally, consider reporting separate codes for specimen collection, if applicable.

8. Historical information

CPT 81234 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient with symptoms of myotonic dystrophy type 1 (DM1) undergoes CPT 81234 to analyze the DMPK gene for the detection of abnormal alleles.
2. A clinician orders CPT 81234 to determine carrier status in a patient with a family history of myotonic dystrophy type 1 (DM1).
3. A patient with muscle wasting and cardiac complications undergoes CPT 81234 to aid in the diagnosis of myotonic dystrophy type 1 (DM1).
4. CPT 81234 is performed on a patient with problems in voluntary muscle control to investigate the possibility of myotonic dystrophy type 1 (DM1).
5. A clinician orders CPT 81234 to analyze the DMPK gene in a patient with symptoms suggestive of myotonic dystrophy type 1 (DM1).
6. A patient with a family history of myotonic dystrophy type 1 (DM1) undergoes CPT 81234 to determine carrier status.
7. CPT 81234 is performed on a patient with muscle wasting and cardiac complications to aid in the diagnosis of myotonic dystrophy type 1 (DM1).
8. A clinician orders CPT 81234 to investigate the possibility of myotonic dystrophy type 1 (DM1) in a patient with problems in voluntary muscle control.
9. A patient with symptoms suggestive of myotonic dystrophy type 1 (DM1) undergoes CPT 81234 to analyze the DMPK gene.
10. CPT 81234 is performed on a patient with a family history of myotonic dystrophy type 1 (DM1) to determine carrier status.