How To Use CPT Code 81255

CPT 81255 describes the genetic analysis procedure for detecting common variants in the HEXA gene, also known as hexosaminidase A [alpha polypeptide]. 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 81255?

CPT 81255 can be used to describe the genetic analysis procedure that detects common variants in the HEXA gene, specifically hexosaminidase A [alpha polypeptide]. This code is used when the lab analyst performs the technical steps to identify the presence of these common changes in the gene.

2. Official Description

The official description of CPT code 81255 is: ‘HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S)’

3. Procedure

1. The lab analyst performs the technical steps of the genetic analysis procedure to detect common variants in the HEXA gene.
2. This includes extracting nucleic acids, amplifying the quantity of nucleic acid for analysis, and detecting the target genes using nucleic acid probes.
3. The test typically includes the common variants listed in the code, such as 1278insTATC, 1421+1G>C, and G269S, but may also include other non-listed variants.

4. Qualifying circumstances

CPT 81255 is commonly ordered by clinicians to help diagnose or determine genetic carrier status for Tay-Sachs disease. This disease involves the progressive destruction of nerve cells in the brain and spinal column. The mutations in the HEXA gene associated with Tay-Sachs are more frequent in people of Ashkenazi Jewish descent. However, this test is not limited to Tay-Sachs disease and can be used to detect common variants in the HEXA gene for other purposes as well.

5. When to use CPT code 81255

CPT code 81255 should be used when the lab analyst performs the genetic analysis procedure to detect common variants in the HEXA gene. It is appropriate to bill this code when testing for any of the more frequent changes in the gene, as indicated by the code description. However, it is important to note that this code does not specify testing for a specific condition, but rather the detection of common variants in the HEXA gene.

6. Documentation requirements

To support a claim for CPT 81255, documentation should include:

• Reason for ordering the test, such as suspected Tay-Sachs disease or other genetic conditions
• Details of the technical steps performed by the lab analyst, including nucleic acid extraction, amplification, and detection methods
• List of common variants tested for, including those listed in the code description and any additional non-listed variants

7. Billing guidelines

When billing for CPT 81255, ensure that the genetic analysis procedure is performed to detect common variants in the HEXA gene. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. Additionally, consider reporting any prep work that precedes the technical steps of the procedure, such as tissue selection or microdissection, using the appropriate codes.

8. Historical information

CPT 81255 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 performs the genetic analysis procedure to detect common variants in the HEXA gene for a patient suspected of having Tay-Sachs disease.
2. A clinician orders CPT 81255 to determine the genetic carrier status of a patient of Ashkenazi Jewish descent for Tay-Sachs disease.
3. A lab analyst performs the genetic analysis procedure to detect common variants in the HEXA gene for research purposes related to genetic disorders.
4. A clinician orders CPT 81255 to investigate the presence of common variants in the HEXA gene for a patient with neurological symptoms.
5. A lab analyst performs the genetic analysis procedure to detect common variants in the HEXA gene for a patient with a family history of Tay-Sachs disease.
6. A clinician orders CPT 81255 to determine the genetic carrier status of a patient planning to start a family.
7. A lab analyst performs the genetic analysis procedure to detect common variants in the HEXA gene for a patient with unexplained developmental delays.
8. A clinician orders CPT 81255 to investigate the presence of common variants in the HEXA gene for a patient with a suspected genetic disorder.
9. A lab analyst performs the genetic analysis procedure to detect common variants in the HEXA gene for a patient with a family history of neurological conditions.
10. A clinician orders CPT 81255 to determine the genetic carrier status of a patient with a known familial variant in the HEXA gene.