How To Use CPT Code 81237

CPT 81237 describes the analysis of the EZH2 gene, specifically targeting common variants such as those in codon 646. 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 81237?

CPT 81237 can be used to describe the analysis of the EZH2 gene, focusing on common variants, particularly those found in codon 646. This code is used when a lab analyst performs the technical steps to detect the presence of specific changes in the EZH2 gene using a specimen such as blood. The analysis involves extracting nucleic acids, amplifying the quantity of nucleic acid for analysis, and detecting the target genes.

2. Official Description

The official description of CPT code 81237 is: ‘EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large B-cell lymphoma) gene analysis, common variant(s) (eg, codon 646).’

3. Procedure

1. The lab analyst performs technical steps to analyze the EZH2 gene, focusing on common variants.
2. A specimen, such as blood, is collected and processed to extract nucleic acids.
3. The quantity of nucleic acid is increased and stabilized for analysis.
4. The target genes, specifically the EZH2 gene, are detected using methods such as polymerase chain reaction (PCR).

4. Qualifying circumstances

CPT 81237 is typically ordered by clinicians to aid in the prognosis of conditions such as myelodysplastic syndrome and myeloproliferative neoplasms. The analysis of the EZH2 gene, particularly common variants in codon 646, can provide valuable information about the patient’s condition and potential prognosis. It is important to note that this test is not limited to a specific condition and can be used in various clinical scenarios.

5. When to use CPT code 81237

CPT code 81237 should be used when there is a clinical need to analyze the EZH2 gene for common variants, particularly those in codon 646. It is important to consider the relevance of this analysis in the context of the patient’s condition and the potential impact on prognosis. This code should not be used for full gene sequence analysis (CPT 81236) or analysis of other specific variants (CPT 81337).

6. Documentation requirements

To support a claim for CPT 81237, documentation should include:

• Reason for ordering the test and its clinical relevance
• Details of the specimen used for analysis
• Specific methods and techniques employed in the analysis
• Results of the analysis, including any identified common variants in codon 646
• Interpretation of the results, if provided by a physician
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81237, ensure that the analysis of the EZH2 gene for common variants, specifically those in codon 646, is performed. It is important to distinguish this code from other related codes, such as CPT 81236 for full gene sequence analysis. Additionally, consider reporting separate codes for specimen collection, if applicable. If physician interpretation is separately requested and provided, modifier 26 can be appended to the billing code.

8. Historical information

CPT 81237 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 lab analyst performing the analysis of the EZH2 gene for common variants in codon 646 to aid in the prognosis of a patient with diffuse large B-cell lymphoma.
2. An oncologist ordering the analysis of the EZH2 gene for common variants in codon 646 to assess the potential prognosis of a patient with myelodysplastic syndrome.
3. A hematologist requesting the analysis of the EZH2 gene for common variants in codon 646 to evaluate the prognosis of a patient with myeloproliferative neoplasms.
4. A pathologist interpreting the results of the analysis of the EZH2 gene for common variants in codon 646 and providing a report on the findings.
5. A genetic counselor discussing the implications of the analysis of the EZH2 gene for common variants in codon 646 with a patient and their family.
6. A researcher using the analysis of the EZH2 gene for common variants in codon 646 to study the genetic basis of diffuse large B-cell lymphoma.
7. A pharmaceutical company conducting clinical trials and utilizing the analysis of the EZH2 gene for common variants in codon 646 as a biomarker for patient selection.
8. A molecular biologist developing new techniques for the analysis of the EZH2 gene for common variants in codon 646.
9. A healthcare administrator reviewing the utilization and cost-effectiveness of the analysis of the EZH2 gene for common variants in codon 646 in their institution.
10. A patient considering genetic testing and discussing the potential benefits and limitations of the analysis of the EZH2 gene for common variants in codon 646 with their healthcare provider.