How To Use CPT Code 81257

CPT 81257 describes the genetic analysis procedure for detecting specific changes and possible deleted nucleotides in the alpha globin 1 and alpha globin 2 genes, also known as HBA1/HBA2. 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 81257?

CPT 81257 can be used to describe the genetic analysis procedure for detecting specific changes and possible deleted nucleotides in the alpha globin 1 and alpha globin 2 genes, also known as HBA1/HBA2. This code is used when the lab analyst performs the technical steps to analyze the genes and identify common deletions or variants associated with conditions such as alpha thalassemia, Hb Bart hydrops fetalis syndrome, and HbH disease.

2. Official Description

The official description of CPT code 81257 is: ‘HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)’

3. Procedure

1. The lab analyst performs the technical steps of the genetic analysis procedure.
2. This includes extracting nucleic acids, such as DNA or RNA, from the patient’s sample.
3. The lab analyst then amplifies and stabilizes the quantity of nucleic acid for analysis.
4. The target genes, HBA1/HBA2, are detected using methods such as nucleic acid probes.
5. The analysis focuses on identifying common deletions or variants in the genes, such as Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, and Constant Spring.
6. Additional non-listed variants may also be included in the analysis.

4. Qualifying circumstances

CPT 81257 is used for patients suspected of having alpha thalassemia or other structural hemoglobinopathies. The analysis focuses on detecting common deletions or variants in the HBA1/HBA2 genes. The frequency of these variants may vary among different ethnic populations, which should be considered when interpreting the test results.

5. When to use CPT code 81257

CPT code 81257 should be used when a genetic analysis procedure is performed to detect common deletions or variants in the HBA1/HBA2 genes. It is commonly ordered to confirm suspected alpha thalassemia, which is often caused by deletions in these genes. This code should not be used for other genetic analyses or full gene sequence analysis.

6. Documentation requirements

To support a claim for CPT 81257, documentation should include:

• Reason for ordering the genetic analysis procedure
• Specific common deletions or variants analyzed
• Date and time of the procedure
• Details of the technical steps performed by the lab analyst
• Interpretation of the test results, if separately requested and provided by a physician

7. Billing guidelines

When billing for CPT 81257, ensure that the procedure is performed to detect common deletions or variants in the HBA1/HBA2 genes. It should not be reported with other codes for different genetic analyses. Additional prep work, such as tissue selection or microdissection, may be separately reported if documented. Physician interpretation of the test results, if separately requested and provided, can be reported with modifier 26.

8. Historical information

CPT 81257 was added to the Current Procedural Terminology system on January 1, 2012. The code description was updated on January 1, 2018 to include specific variants and deletions.

9. Examples

1. A lab analyst performing a genetic analysis procedure to detect common deletions or variants in the HBA1/HBA2 genes for a patient suspected of having alpha thalassemia.
2. An analysis focusing on Southeast Asian variants in the HBA1/HBA2 genes for a patient with suspected alpha thalassemia.
3. A genetic analysis procedure to identify the Constant Spring variant in the HBA1/HBA2 genes for a patient with suspected structural hemoglobinopathy.
4. A lab analyst performing the technical steps of the genetic analysis procedure to detect Mediterranean variants in the HBA1/HBA2 genes for a patient with suspected alpha thalassemia.
5. An analysis focusing on alpha3.7 and alpha4.2 deletions in the HBA1/HBA2 genes for a patient with suspected HbH disease.
6. A genetic analysis procedure to detect Thai variants in the HBA1/HBA2 genes for a patient with suspected alpha thalassemia.
7. A lab analyst performing the analysis for alpha20.5 variant in the HBA1/HBA2 genes for a patient with suspected structural hemoglobinopathy.
8. An analysis focusing on Filipino variants in the HBA1/HBA2 genes for a patient with suspected alpha thalassemia.
9. A genetic analysis procedure to detect non-listed variants in the HBA1/HBA2 genes for a patient with suspected structural hemoglobinopathy.
10. An analysis focusing on multiple common deletions and variants in the HBA1/HBA2 genes for a patient with suspected alpha thalassemia.