How To Use CPT Code 81235

CPT 81235 describes the genetic analysis procedure for detecting common variants in the epidermal growth factor receptor (EGFR) gene, particularly in cases of non-small cell lung cancer. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81235?

CPT 81235 can be used to identify common variants in the EGFR gene, specifically in relation to non-small cell lung cancer. This code is utilized when performing a genetic analysis procedure to detect these variants in patients.

2. Official Description

The official description of CPT code 81235 is: ‘EGFR (epidermal growth factor receptor) (eg, non-small cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q).’ This code represents the testing for common changes in the EGFR gene, including specific variants listed in the code, as well as potentially other non-listed variants.

3. Procedure

1. The lab analyst performs various technical steps, such as extracting nucleic acids, amplifying the quantity of nucleic acid for analysis, and detecting the target genes using nucleic acid probes.

4. Qualifying circumstances

CPT 81235 is typically ordered for patients with advanced non-small cell lung cancer who are being considered for treatment with a tyrosine kinase inhibitor (TKI). This test helps identify specific EGFR mutations that may indicate the suitability of TKI therapy instead of chemotherapy.

5. When to use CPT code 81235

CPT code 81235 should be used when performing a genetic analysis procedure to detect common variants in the EGFR gene, particularly in cases of non-small cell lung cancer. It is important to ensure that the patient meets the qualifying circumstances for this test.

6. Documentation requirements

To support a claim for CPT 81235, documentation should include:

• Indication of the patient’s advanced non-small cell lung cancer and consideration for TKI therapy
• Specific variants tested for, including exon 19 LREA deletion, L858R, T790M, G719A, G719S, and L861Q
• Date and details of the genetic analysis procedure performed
• Results of the analysis and any additional relevant information
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81235, ensure that the procedure is performed for the detection of common variants in the EGFR gene, specifically in relation to non-small cell lung cancer. It is important to follow any additional guidelines provided by payers regarding the reporting of this code.

8. Historical information

CPT 81235 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A patient with advanced non-small cell lung cancer undergoes a genetic analysis procedure to detect common variants in the EGFR gene, including exon 19 LREA deletion, L858R, T790M, G719A, G719S, and L861Q.
2. A physician orders a genetic analysis procedure for a patient with non-small cell lung cancer to determine the suitability of tyrosine kinase inhibitor therapy based on specific EGFR mutations.
3. A lab analyst performs a genetic analysis procedure to identify common variants in the EGFR gene for a patient with advanced non-small cell lung cancer.
4. A patient with non-small cell lung cancer undergoes a genetic analysis procedure to detect specific EGFR mutations, including exon 19 LREA deletion, L858R, T790M, G719A, G719S, and L861Q.
5. A genetic analysis procedure is performed on a patient with advanced non-small cell lung cancer to assess the presence of common variants in the EGFR gene.
6. A lab technician conducts a genetic analysis procedure to detect specific EGFR mutations in a patient with non-small cell lung cancer.
7. A physician orders a genetic analysis procedure to identify common variants in the EGFR gene for a patient with advanced non-small cell lung cancer.
8. A patient with non-small cell lung cancer undergoes a genetic analysis procedure to determine the presence of specific EGFR mutations, including exon 19 LREA deletion, L858R, T790M, G719A, G719S, and L861Q.
9. A lab analyst performs a genetic analysis procedure to detect common variants in the EGFR gene for a patient with advanced non-small cell lung cancer.
10. A genetic analysis procedure is conducted on a patient with non-small cell lung cancer to assess the presence of specific EGFR mutations.