How To Use CPT Code 81268

CPT 81268 describes the process of chimerism analysis, specifically for post-transplantation specimens, such as hematopoietic stem cells. 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 81268?

CPT 81268 can be used to describe the analysis of chimerism or engraftment in post-transplantation specimens, specifically hematopoietic stem cells. This code is used to compare the STR markers from the post-transplant specimen with the initial donor specimen to determine the success of the transplant or the recurrence of a disease. The analysis may also include the evaluation of lineage-specific cell subsets, such as CD3 positive T-cells.

2. Official Description

The official description of CPT code 81268 is: ‘Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each cell type.’

3. Procedure

1. The lab analyst performs the technical steps to evaluate the genetic similarity or difference of STR sequences between the patient’s post-transplant specimen and the donor’s previously tested 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 the DNA fragment size of the separated sequences.
3. The analysis may also involve testing lineage-specific cell subsets, such as CD3 positive T-cells.
4. The comparison is made to determine the level of chimerism or engraftment in the post-transplant specimen and assess the success of the transplant or the recurrence of a disease.

4. Qualifying circumstances

CPT 81268 is used for post-transplantation specimens, specifically hematopoietic stem cells. It is typically ordered by clinicians to evaluate the success of a transplant, detect disease recurrence, evaluate graft rejection, or determine the origin of donor cells for a possible second transplant. The analysis may also include the evaluation of lineage-specific cell subsets, such as CD3 or CD33 positive cells.

5. When to use CPT code 81268

CPT code 81268 should be used when analyzing post-transplantation specimens, such as hematopoietic stem cells, to determine chimerism or engraftment. It is appropriate to use this code when comparing the STR markers from the post-transplant specimen with the previously tested donor specimen. The analysis may also include the evaluation of lineage-specific cell subsets, such as CD3 or CD33 positive cells.

6. Documentation requirements

To support a claim for CPT 81268, the documentation should include:

• Indication for the chimerism analysis and the reason for the post-transplantation specimen
• Details of the technical steps performed, including the extraction of nucleic acids, amplification of STR sequences, separation of sequences, and comparison of DNA fragment size
• Evaluation of lineage-specific cell subsets, if applicable
• Results of the analysis, including the level of chimerism or engraftment
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81268, ensure that the analysis is performed on post-transplantation specimens, such as hematopoietic stem cells. The code includes the technical work for evaluating chimerism or engraftment, as well as the comparison to previously performed baseline analyses. It may also include the evaluation of lineage-specific cell subsets. There is no need to report an additional unit of CPT code 81265. If the lab analyst performs the STR analysis on both pre- and post-transplant specimens at the same time, CPT codes 81265 and 81268 can be reported together, along with additional code 81266 if appropriate.

8. Historical information

CPT 81268 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 performs chimerism analysis on a post-transplantation hematopoietic stem cell specimen, comparing it to the previously tested donor specimen to determine the success of the transplant.
2. Chimerism analysis is performed on a post-transplantation specimen, including the evaluation of lineage-specific cell subsets, such as CD3 positive T-cells, to assess the level of engraftment.
3. A clinician orders chimerism analysis on a post-transplantation specimen to evaluate graft rejection and determine the origin of donor cells for a possible second transplant.
4. The lab analyst compares the STR markers from a post-transplantation specimen to the previously tested donor specimen to detect disease recurrence.
5. Chimerism analysis is performed on a post-transplantation hematopoietic stem cell specimen, including the evaluation of lineage-specific cell subsets, such as CD33 positive cells, to assess the success of the transplant.
6. A clinician orders chimerism analysis on a post-transplantation specimen to evaluate the origin of donor cells for a possible second transplant and assess the level of engraftment.
7. The lab analyst performs chimerism analysis on a post-transplantation hematopoietic stem cell specimen, comparing it to the previously tested donor specimen to determine the success of the transplant.
8. Chimerism analysis is performed on a post-transplantation specimen, including the evaluation of lineage-specific cell subsets, such as CD3 positive T-cells, to assess the level of engraftment.