How To Use CPT Code 81240

CPT 81240 describes the genetic analysis procedure for detecting common changes in the F2 gene, specifically the 20210G>A variant. 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 81240?

CPT 81240 can be used to describe the genetic analysis procedure performed by a lab analyst to detect common changes in the F2 gene, specifically the 20210G>A variant. This test aids in the diagnosis of prothrombin thrombophilia, a form of hypercoagulability related to the 20210G>A mutation in the F2 gene that causes excessive blood clotting.

2. Official Description

The official description of CPT code 81240 is: ‘F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant.’

3. Procedure

1. The lab analyst performs the technical lab test to detect the presence of common changes in the F2 gene, specifically the 20210G>A variant.
2. The procedure involves extracting nucleic acids from the patient’s sample, such as through cell lysis and digestion.
3. The lab analyst then amplifies and stabilizes the quantity of nucleic acid for analysis, using methods such as polymerase chain reaction (PCR) or transcription of DNA to RNA and reverse transcription from RNA to make an additional copy of the DNA.
4. The target genes, including the 20210G>A variant, are detected using methods such as nucleic acid probes.

4. Qualifying circumstances

CPT 81240 is commonly ordered for patients with hypercoagulability, a condition involving excessive blood clotting. It aids in the diagnosis of prothrombin thrombophilia, which is related to the 20210G>A mutation in the F2 gene. This mutation causes an over-production of prothrombin, leading to excessive blood clotting. The test can be ordered by clinicians for patients suspected of having hereditary hypercoagulability.

5. When to use CPT code 81240

CPT code 81240 should be used when a genetic analysis procedure is performed to detect the 20210G>A variant in the F2 gene. It is appropriate to use this code when the test aids in the diagnosis of prothrombin thrombophilia or other conditions related to the 20210G>A mutation. However, it should not be used for testing unrelated to the F2 gene or the 20210G>A variant.

6. Documentation requirements

To support a claim for CPT 81240, the documentation should include:

• Indication of the need for genetic analysis
• Specific details of the F2 gene analysis, including the detection of the 20210G>A variant
• Date and time of the procedure
• Results of the analysis
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81240, ensure that the procedure is performed by a lab analyst and that the specific 20210G>A variant is being analyzed. It is important to follow the guidelines set by the payer regarding the reporting of this code. Additionally, if the ordering clinician requests physician interpretation of the test and the pathologist provides an interpretation and writes a report, you may need to report an additional code, such as G0452 with modifier 26, depending on the payer’s requirements.

8. Historical information

CPT 81240 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 lab analyst performing a genetic analysis procedure to detect the 20210G>A variant in the F2 gene for a patient suspected of having prothrombin thrombophilia.
2. A clinician ordering CPT 81240 for a patient with a family history of hereditary hypercoagulability to confirm the presence of the 20210G>A variant in the F2 gene.
3. A lab analyst conducting a genetic analysis to detect the 20210G>A variant in the F2 gene for a patient with a history of deep vein thrombosis.
4. A clinician ordering CPT 81240 for a patient with unexplained excessive blood clotting to determine if the 20210G>A variant in the F2 gene is present.
5. A lab analyst performing a genetic analysis procedure to detect the 20210G>A variant in the F2 gene for a patient undergoing surgery to assess their risk of excessive blood clotting.
6. A clinician ordering CPT 81240 for a patient with recurrent miscarriages to investigate if the 20210G>A variant in the F2 gene is a contributing factor.
7. A lab analyst conducting a genetic analysis to detect the 20210G>A variant in the F2 gene for a patient with a history of pulmonary embolism.
8. A clinician ordering CPT 81240 for a patient with a history of stroke to determine if the 20210G>A variant in the F2 gene is present.
9. A lab analyst performing a genetic analysis procedure to detect the 20210G>A variant in the F2 gene for a patient with a family history of prothrombin thrombophilia.
10. A clinician ordering CPT 81240 for a patient with unexplained thrombophilia to investigate if the 20210G>A variant in the F2 gene is a contributing factor.