How To Use CPT Code 81260

CPT 81260 describes the genetic analysis procedure for detecting common changes in the IKBKAP gene, also known as inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein. 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 81260?

CPT 81260 can be used to describe the genetic analysis procedure that detects common changes in the IKBKAP gene. This code is used when the lab analyst performs the technical steps to identify the presence of specific variants in the gene, such as 2507+6T>C and R696P.

2. Official Description

The official description of CPT code 81260 is: ‘IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P)’

3. Procedure

1. The lab analyst performs the technical steps of the genetic analysis procedure to detect common changes in the IKBKAP 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 variants listed in the code, such as 2507+6T>C and R696P, but may also include other non-listed variants.

4. Qualifying circumstances

CPT 81260 is commonly ordered by clinicians to confirm a clinical diagnosis of familial dysautonomia or to determine carrier status for known familial mutations in at-risk populations of Ashkenazi Jewish descent. Familial dysautonomia is a condition caused by mutations in the IKBKAP gene, which affects the production of a protein involved in cell structure and movement, particularly in nerve cells related to the involuntary nervous system.

5. When to use CPT code 81260

CPT code 81260 should be used when the lab analyst performs the genetic analysis procedure to detect common changes in the IKBKAP gene. It is appropriate to bill this code when testing for any of the more frequent variants listed in the code, such as 2507+6T>C and R696P.

6. Documentation requirements

To support a claim for CPT 81260, the documentation should include:

• Reason for ordering the test, such as confirming a clinical diagnosis of familial dysautonomia or determining carrier status for known familial mutations
• Details of the technical steps performed by the lab analyst, including nucleic acid extraction, amplification, and detection of target genes
• List of variants tested, including the specific common variants listed in the code

7. Billing guidelines

When billing for CPT 81260, ensure that the genetic analysis procedure is performed to detect common changes in the IKBKAP gene. It is important to note that this code represents testing for any of the more frequent variants listed in the code, and may include other non-listed variants. There are no specific guidelines regarding reporting CPT 81260 with other codes.

8. Historical information

CPT 81260 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 changes in the IKBKAP gene for a patient suspected of having familial dysautonomia.
2. A clinician ordering CPT 81260 to determine carrier status for known familial mutations in the IKBKAP gene for an individual of Ashkenazi Jewish descent.
3. A lab technician conducting the genetic analysis procedure to confirm a clinical diagnosis of familial dysautonomia by detecting specific variants in the IKBKAP gene.
4. A patient undergoing CPT 81260 to assess their risk of developing familial dysautonomia based on the presence of common changes in the IKBKAP gene.
5. A genetic counselor recommending CPT 81260 to a patient with a family history of familial dysautonomia to determine their carrier status for known mutations in the IKBKAP gene.
6. A lab scientist performing the genetic analysis procedure to identify common variants in the IKBKAP gene for research purposes.
7. A clinician ordering CPT 81260 to confirm a suspected diagnosis of familial dysautonomia in a patient exhibiting symptoms associated with the condition.
8. A lab analyst conducting the genetic analysis procedure to detect common changes in the IKBKAP gene for a patient with unexplained autonomic dysfunction.
9. A geneticist recommending CPT 81260 to assess the risk of familial dysautonomia in a patient planning to start a family.
10. A lab technician performing the genetic analysis procedure to determine the presence of common variants in the IKBKAP gene for a patient with a family history of familial dysautonomia.