How To Use CPT Code 81274

CPT 81274 describes the genetic analysis procedure for the huntingtin (HTT) gene, specifically the characterization of alleles, such as expanded size. 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 81274?

CPT 81274 can be used to describe the genetic analysis procedure for the huntingtin (HTT) gene. This code specifically characterizes alleles, such as expanded size, following the detection of abnormal alleles in the specimen. The test helps to identify nucleotide repeats and determine the methylation status of the gene.

2. Official Description

The official description of CPT code 81274 is: ‘HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles (eg, expanded size)’

3. Procedure

1. The lab analyst performs the technical lab test to characterize changes in the huntingtin gene (HTT), typically to identify nucleotide repeats following detection of an expanded allele size.
2. The lab analyst may use methods such as Southern blot or methylation-specific multiplex ligation dependent probe amplification (MLPA) to characterize the nucleotide repeats and methylation status.
3. A single unit of CPT 81274 represents characterizing the HTT gene based on specific details of expanded or other abnormal alleles, such as CAG trinucleotide repeat.
4. If the lab performs two distinct medically-necessary assays, both CPT 81271 (detection of abnormal alleles) and CPT 81274 (characterization of abnormal alleles) can be reported.

4. Qualifying circumstances

CPT 81274 is typically ordered by clinicians to aid in the diagnosis of Huntington disease (HD), a heritable disease characterized by psychiatric symptoms and progressive deterioration of motor and cognitive functions. It may also be ordered to determine carrier status. The test is performed when abnormal alleles are detected in the specimen, and further characterization of the abnormal alleles is required.

5. When to use CPT code 81274

CPT code 81274 should be used when there is a need to characterize abnormal alleles detected in the HTT gene. It is important to distinguish between CPT 81271 (detection of abnormal alleles) and CPT 81274 (characterization of abnormal alleles) to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT 81274, documentation should include:

• Indication of the need for the test and the detection of abnormal alleles
• Details of the specific abnormal alleles being characterized, such as expanded size or other specific variants
• Method used for characterization, such as Southern blot or methylation-specific MLPA
• Date and time of the test
• Results of the characterization
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81274, it is important to ensure that the test is performed following the detection of abnormal alleles. The specimen collection may be separately billed using a code such as 36415. If the ordering clinician requests physician interpretation and the pathologist provides an interpretation and report, modifier 26 may be added to code G0452 for Medicare and other payers. It is crucial to accurately distinguish between CPT 81271 and CPT 81274 to avoid reporting both codes when the single assay includes characterization of alleles.

8. Historical information

CPT 81274 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes genetic testing for the HTT gene, and abnormal alleles are detected. The lab analyst performs CPT 81274 to characterize the abnormal alleles, specifically identifying the expanded size of the nucleotide repeats.
2. A clinician orders HTT gene analysis for a patient suspected of having Huntington disease. The lab performs CPT 81274 to characterize the abnormal alleles and confirm the diagnosis.
3. A patient undergoes genetic testing to determine their carrier status for Huntington disease. CPT 81274 is performed to characterize the abnormal alleles and provide the necessary information.
4. Following the detection of abnormal alleles in the HTT gene, the lab analyst performs CPT 81274 to characterize the nucleotide repeats and determine the methylation status.
5. A patient with a family history of Huntington disease undergoes HTT gene analysis. CPT 81274 is performed to characterize the abnormal alleles and assess the patient’s risk.