How To Use CPT Code 81265

CPT 81265 describes the process of performing a comparative analysis using Short Tandem Repeat (STR) markers. 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 81265?

CPT 81265 can be used to describe the process of comparing genetic similarity or difference between a patient and a comparative specimen using Short Tandem Repeat (STR) markers. This code is used when a lab analyst performs the technical steps involved in evaluating STR sequences, such as extracting nucleic acids, amplifying the sequences using polymerase chain reaction (PCR), separating the sequences by electrophoresis, and comparing DNA fragment size. The purpose of this analysis is to determine the genetic relationship between the patient and the comparative specimen.

2. Official Description

The official description of CPT code 81265 is: ‘Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline [eg, buccal swab or other germline tissue sample] and donor testing, twin zygosity testing, or maternal cell contamination of fetal cells).’

3. Procedure

1. The lab analyst performs all technical steps involved in the comparative analysis of STR markers.
2. This includes extracting nucleic acids from the patient and comparative specimen, amplifying the STR sequences using PCR, separating the sequences by electrophoresis, and comparing DNA fragment size.
3. The lab analyst may use computer-assisted analysis of multiple STR loci to determine the genetic relationship between the patient and the comparative specimen.

4. Qualifying circumstances

CPT 81265 is typically used in various circumstances, such as pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline testing, twin zygosity testing, or maternal cell contamination of fetal cells. It is important to note that this code is not limited to testing for a specific condition and can be used in other scenarios where a comparative analysis of STR markers is required.

5. When to use CPT code 81265

CPT code 81265 should be used when there is a need to compare the genetic similarity or difference between a patient and a comparative specimen using STR markers. It is important to ensure that the analysis involves the evaluation of STR sequences and the determination of genetic relationship. This code should not be used for other types of genetic tests that do not involve STR markers.

6. Documentation requirements

To support a claim for CPT code 81265, the documentation should include:

• Reason for the comparative analysis using STR markers
• Details of the technical steps performed, including nucleic acid extraction, PCR amplification, electrophoresis, and DNA fragment size comparison
• Results of the analysis, including the genetic relationship between the patient and the comparative specimen
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 81265, it is important to ensure that the analysis involves the use of STR markers and the comparison of genetic similarity or difference between a patient and a comparative specimen. This code should not be reported with other codes unless there are specific circumstances that require additional testing or interpretation. It is recommended to review payer guidelines and consult with coding experts to ensure accurate and appropriate billing.

8. Historical information

CPT code 81265 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 a comparative analysis using STR markers to determine the genetic relationship between a pre-transplant recipient and donor.
2. An analysis of STR markers to evaluate the genetic similarity between twins and determine if they are genetically identical.
3. A comparative analysis using STR markers to detect maternal cell contamination in fetal cells for a patient diagnosed with Severe Combined Immuno-Deficiency (SCID).
4. Comparative testing of STR markers to assess the genetic relationship between a post-transplant non-hematopoietic recipient and donor.
5. An analysis of STR markers to determine the genetic relationship between a patient and a comparative specimen for forensic purposes.
6. Comparative analysis using STR markers to evaluate the genetic similarity between siblings and determine if they are full or half siblings.
7. A lab analyst performing a comparative analysis using STR markers to determine the genetic relationship between a patient and a comparative specimen for immigration purposes.
8. An analysis of STR markers to assess the genetic relationship between a patient and a comparative specimen for genealogical research.
9. Comparative testing of STR markers to determine the genetic relationship between a patient and a potential organ donor.
10. An analysis of STR markers to evaluate the genetic similarity between a patient and a comparative specimen for paternity testing.