How To Use CPT Code 81238

CPT 81238 describes the analysis of the full gene sequence of the coagulation factor IX (F9) 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 81238?

CPT 81238 can be used to describe the analysis of the full gene sequence of the coagulation factor IX (F9) gene. This code is used when a lab analyst performs the technical lab test to analyze the entire gene sequence of the F9 gene. The test involves extracting nucleic acids, amplifying the gene, and detecting the target genes using methods such as nucleic acid probes. The specimen used for this test is typically blood.

2. Official Description

The official description of CPT code 81238 is: ‘F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence.’

3. Procedure

1. The lab analyst performs the technical steps required for the analysis of the full gene sequence of the F9 gene.
2. This includes extracting nucleic acids from a specimen, such as blood, using methods like digestion and cell lysis.
3. The lab analyst then amplifies the gene sequence, making more copies of the desired gene for study.
4. The target genes are detected using methods such as nucleic acid probes.
5. The entire process aims to analyze the full gene sequence of the F9 gene.

4. Qualifying circumstances

CPT 81238 is typically ordered by clinicians to evaluate patients for possible gene mutations involved in factor IX deficiency, also known as Christmas disease or hemophilia B. It may also be ordered for genetic counseling purposes to determine carrier status for women, as this is a recessive X-linked trait. The test can be performed on patients of any age or gender.

5. When to use CPT code 81238

CPT code 81238 should be used when a lab analyst performs the analysis of the full gene sequence of the F9 gene. It is appropriate to use this code when the test is ordered to evaluate patients for gene mutations related to factor IX deficiency or for genetic counseling purposes. This code should not be used for other genetic analysis procedures or for testing unrelated to the F9 gene.

6. Documentation requirements

To support a claim for CPT 81238, documentation should include:

• Reason for ordering the test, such as evaluation for gene mutations related to factor IX deficiency or genetic counseling
• Details of the technical steps performed by the lab analyst, including nucleic acid extraction, gene amplification, and target gene detection
• Specimen used for the test, such as blood
• Results of the analysis, including the full gene sequence of the F9 gene
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81238, ensure that the test is performed by a lab analyst and that the full gene sequence of the F9 gene is analyzed. It is important to use the appropriate diagnosis code to support medical necessity. Additional codes may be reported for specimen collection or prep work, if applicable. If the pathologist provides an interpretation and report, a separate code for physician interpretation may be reported with modifier 26.

8. Historical information

CPT 81238 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the analysis of the full gene sequence of the F9 gene to evaluate a patient for possible gene mutations related to factor IX deficiency.
2. A clinician ordering CPT 81238 for genetic counseling purposes to determine carrier status for a woman with a family history of hemophilia B.
3. A lab analyst analyzing the full gene sequence of the F9 gene in a newborn baby suspected to have factor IX deficiency.
4. A clinician ordering CPT 81238 to evaluate a patient with unexplained bleeding disorders for possible gene mutations in the F9 gene.
5. A lab analyst performing the analysis of the full gene sequence of the F9 gene to confirm a diagnosis of hemophilia B in a patient with clinical symptoms.
6. A clinician ordering CPT 81238 to assess the risk of factor IX deficiency in a pregnant woman with a family history of the condition.
7. A lab analyst analyzing the full gene sequence of the F9 gene in a patient with abnormal coagulation test results to identify potential gene mutations.
8. A clinician ordering CPT 81238 to determine carrier status for a woman planning to have children with a partner who has hemophilia B.
9. A lab analyst performing the analysis of the full gene sequence of the F9 gene in a patient with suspected factor IX deficiency to guide treatment decisions.
10. A clinician ordering CPT 81238 to evaluate a patient with a family history of hemophilia B for possible gene mutations in the F9 gene.