How To Use CPT Code 81266

CPT 81266 describes the process of comparative analysis using Short Tandem Repeat (STR) markers. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81266?

CPT 81266 can be used to describe the process of comparative analysis using Short Tandem Repeat (STR) markers. This code is used when a lab analyst performs the technical lab test to evaluate genetic similarity or difference of STR sequences between the patient and a third or subsequent comparative specimen. The test involves extracting nucleic acids, amplifying the STR sequences using polymerase chain reaction (PCR), separating the sequences by electrophoresis, and comparing DNA fragment size of separated sequences for the patient and each subsequent comparative specimen.

2. Official Description

The official description of CPT code 81266 is: ‘Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 81265.

3. Procedure

1. The lab analyst performs all technical steps to evaluate genetic similarity or difference of STR sequences between the patient and a third or subsequent comparative specimen.
2. The technical steps include extracting nucleic acids, amplifying the STR sequences using polymerase chain reaction (PCR), separating the sequences by electrophoresis, and comparing DNA fragment size of separated sequences for the patient and each subsequent comparative specimen.
3. Computer-assisted analysis of multiple STR loci is often used to compare the genetic similarity.

4. Qualifying circumstances

CPT 81266 is used when there is a need to compare genetic similarity or difference between the patient and a third or subsequent comparative specimen. This could include additional cord blood donors, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies. The test is commonly ordered for pre-transplant donor and recipient testing involving cord blood from more than one donor, or to verify if multiple-birth infants are genetically identical.

5. When to use CPT code 81266

CPT code 81266 should be used when the lab analyst performs the technical lab test to evaluate genetic similarity or difference of STR sequences between the patient and a third or subsequent comparative specimen. This code should be used in addition to the primary procedure code (CPT code 81265).

6. Documentation requirements

To support a claim for CPT code 81266, the documentation should include:

• Indication of the need for comparative analysis using STR markers
• Details of the technical steps performed, including nucleic acid extraction, amplification of STR sequences, electrophoresis, and comparison of DNA fragment size
• Computer-assisted analysis of multiple STR loci, if applicable
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 81266, ensure that the lab analyst performs the technical lab test to evaluate genetic similarity or difference of STR sequences between the patient and a third or subsequent comparative specimen. This code should be listed separately in addition to the primary procedure code (CPT code 81265). If the ordering clinician separately requests physician interpretation of the test and the pathologist renders an interpretation and writes a report, you can additionally report G0452 with modifier 26 to Medicare and perhaps other payers.

8. Historical information

CPT code 81266 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 comparative analysis using STR markers to evaluate genetic similarity between the patient and an additional cord blood donor.
2. A lab analyst comparing STR sequences between the patient and a third infant for multiple-birth zygosity testing.
3. A lab analyst evaluating genetic similarity between the patient and an additional fetal sample from a different culture.
4. A lab analyst performing comparative analysis using STR markers to verify if multiple-birth infants are genetically identical.
5. A lab analyst comparing STR sequences between the patient and an additional specimen for pre-transplant donor and recipient testing.
6. A lab analyst evaluating genetic similarity between the patient and an additional specimen for research purposes.
7. A lab analyst performing comparative analysis using STR markers to determine genetic similarity between the patient and an additional specimen for forensic investigations.
8. A lab analyst comparing STR sequences between the patient and an additional specimen for genetic counseling purposes.
9. A lab analyst evaluating genetic similarity between the patient and an additional specimen for paternity testing.
10. A lab analyst performing comparative analysis using STR markers to determine genetic similarity between the patient and an additional specimen for ancestry testing.