How To Use CPT Code 81256

CPT 81256 describes the genetic analysis procedure for detecting common variants in the hemochromatosis gene, also known as HFE. 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 81256?

CPT 81256 can be used to describe the genetic analysis procedure performed to detect common variants in the hemochromatosis gene, specifically the HFE gene. This code is used when the lab analyst performs the technical steps involved in analyzing the nucleic acids and detecting the target genes associated with hemochromatosis.

2. Official Description

The official description of CPT code 81256 is: ‘HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D).’ This code represents the testing for common changes in the HFE gene, including variants such as C282Y and H63D, which are frequently associated with hemochromatosis.

3. Procedure

1. The lab analyst performs the technical steps involved in the genetic analysis procedure for detecting common variants in the HFE gene.
2. This includes extracting nucleic acids from the sample, amplifying and stabilizing the quantity of nucleic acid for analysis, and detecting the target genes using nucleic acid probes.
3. The procedure may also involve other techniques such as polymerase chain reaction (PCR) or transcription of DNA to RNA and reverse transcription from RNA to make additional copies of the DNA.

4. Qualifying circumstances

CPT 81256 is typically ordered for patients with abnormal blood iron status or symptoms indicative of suspected type 1 hemochromatosis. It is also ordered for asymptomatic patients with a family history of the disease. The test is not limited to a specific condition but is commonly used to detect common variants in the HFE gene associated with hemochromatosis.

5. When to use CPT code 81256

CPT code 81256 should be used when performing the genetic analysis procedure to detect common variants in the HFE gene. It is appropriate to bill this code when analyzing the nucleic acids and detecting the target genes associated with hemochromatosis. This code should not be used for other genetic analysis procedures or for testing specific conditions other than hemochromatosis.

6. Documentation requirements

To support a claim for CPT 81256, documentation should include:

• Indication for the test, such as abnormal blood iron status or symptoms suggestive of hemochromatosis
• Details of the genetic analysis procedure performed, including the techniques used and the specific variants tested
• Date of the procedure
• Results of the analysis, including the presence or absence of common variants in the HFE gene
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81256, ensure that the procedure performed is specifically for the genetic analysis of common variants in the HFE gene. This code should not be reported with other codes unless there are separate prep work or physician interpretation services provided. It is important to follow the guidelines of the specific payer when reporting this code.

8. Historical information

CPT 81256 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 the genetic analysis procedure to detect common variants in the HFE gene for a patient with abnormal blood iron levels.
2. An asymptomatic patient with a family history of hemochromatosis undergoing the genetic analysis procedure to determine their risk of developing the condition.
3. A clinician ordering the genetic analysis procedure for a patient with symptoms suggestive of hemochromatosis, such as fatigue and joint pain.
4. A lab analyst analyzing the nucleic acids and detecting the target genes associated with hemochromatosis using nucleic acid probes.
5. A patient with suspected type 1 hemochromatosis undergoing the genetic analysis procedure to confirm the presence of common variants in the HFE gene.
6. A lab analyst performing the technical steps involved in the genetic analysis procedure, including amplification and detection of the target genes.
7. A clinician ordering the genetic analysis procedure for a patient with a family history of hemochromatosis, even in the absence of symptoms.
8. A lab analyst documenting the results of the genetic analysis procedure, indicating the presence or absence of common variants in the HFE gene.
9. A patient with abnormal blood iron status undergoing the genetic analysis procedure to determine the underlying cause.
10. A lab analyst performing the genetic analysis procedure for a patient with symptoms suggestive of hemochromatosis, such as liver disease and heart problems.