How To Use CPT Code 81259

CPT 81259 describes the full gene sequence analysis for the HBA1/HBA2 genes, which are related to alpha thalassemia and some structural hemoglobinopathies. 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 81259?

CPT 81259 can be used to describe the full gene sequence analysis for the HBA1/HBA2 genes. This code is used to analyze the entire gene sequence for alpha globin 1 and alpha globin 2, which are associated with alpha thalassemia and some structural hemoglobinopathies. The test is performed by a lab analyst who performs all technical steps, from extracting the nucleic acids to detecting the target genes using a specimen such as blood.

2. Official Description

The official description of CPT code 81259 is: ‘HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence.’

3. Procedure

1. The lab analyst extracts the nucleic acids from the specimen, such as blood, using methods like digestion and cell lysis.
2. The lab analyst amplifies the nucleic acids to increase and stabilize the quantity for analysis.
3. The lab analyst detects the target genes, HBA1/HBA2, using methods like nucleic acid probes.
4. The lab analyst performs a full gene sequence analysis for the HBA1/HBA2 genes.

4. Qualifying circumstances

CPT 81259 is typically ordered as a second-tier evaluation for screening possible genetic carriers or diagnosing alpha thalassemia and some hemoglobinopathies. Alpha thalassemia can take various forms, depending on the number of inherited HBA1/HBA2 alleles exhibiting a mutation. The variants involved in alpha thalassemia occur with varying frequency in different ethnic populations, which may impact the interpretation of test results.

5. When to use CPT code 81259

CPT code 81259 should be used when there is a need for full gene sequence analysis of the HBA1/HBA2 genes. It is typically ordered as a second-tier evaluation for screening possible genetic carriers or diagnosing alpha thalassemia and some hemoglobinopathies. It is important to note that CPT code 81259 should not be used as a first-tier test, as the majority of cases exhibit one of the common deletions, which is covered by CPT code 81257.

6. Documentation requirements

To support a claim for CPT code 81259, the documentation should include:

• Reason for ordering the test, such as screening or diagnosis
• Specific gene being analyzed (HBA1/HBA2)
• Date of the test
• Results of the full gene sequence analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 81259, ensure that the full gene sequence analysis for the HBA1/HBA2 genes is performed. It is important to distinguish this code from other codes in the HBA1/HBA2 genetic testing code family, such as CPT code 81257 for common deletions or variants, CPT code 81258 for known familial variants, and CPT code 81269 for duplication deletion analysis. Additional codes may be reported for specimen collection or interpretation by a physician, if applicable.

8. Historical information

CPT code 81259 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 a full gene sequence analysis for the HBA1/HBA2 genes to diagnose alpha thalassemia in a patient.
2. A genetic counselor ordering a second-tier evaluation for screening possible genetic carriers of alpha thalassemia and requesting a full gene sequence analysis for the HBA1/HBA2 genes.
3. A hematologist ordering a full gene sequence analysis for the HBA1/HBA2 genes to investigate a suspected hemoglobinopathy in a patient.
4. A pediatrician ordering a full gene sequence analysis for the HBA1/HBA2 genes to diagnose Hb Bart hydrops fetalis syndrome in a newborn.
5. A geneticist performing a full gene sequence analysis for the HBA1/HBA2 genes to identify known familial variants in a family with a history of alpha thalassemia.
6. A lab analyst analyzing the entire gene sequence for alpha globin 1 and alpha globin 2 to determine the presence of structural hemoglobinopathies in a patient.
7. A hematopathologist performing a full gene sequence analysis for the HBA1/HBA2 genes to investigate a suspected hemoglobinopathy in a patient with abnormal hemoglobin levels.
8. A genetic counselor ordering a full gene sequence analysis for the HBA1/HBA2 genes to confirm a diagnosis of HbH disease in a patient.
9. A lab analyst performing a full gene sequence analysis for the HBA1/HBA2 genes to identify duplication variants in a patient with suspected alpha thalassemia.