How To Use CPT Code 81275

CPT 81275 describes the analysis of the KRAS gene to detect common changes in exon 2. 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 81275?

CPT 81275 can be used to analyze the KRAS gene and detect common changes in exon 2. This code is specifically used to identify variants in codons 12 and 13 of the KRAS gene, which are somatic mutations that occur during a patient’s lifetime and can be associated with certain cancers.

2. Official Description

The official description of CPT code 81275 is: ‘KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13)’. This code represents the testing for common changes in the KRAS gene, specifically in exon 2.

3. Procedure

1. The lab analyst performs the technical lab test to detect common changes in the KRAS gene, specifically in exon 2.
2. The lab analyst extracts nucleic acids from the patient’s sample, such as through digestion and cell lysis.
3. The lab analyst amplifies the nucleic acids to increase and stabilize the quantity of the KRAS gene for analysis.
4. The lab analyst detects the target genes, such as using nucleic acid probes, to identify any variants in codons 12 and 13 of the KRAS gene.

4. Qualifying circumstances

CPT 81275 is typically ordered by clinicians for diagnostic, prognostic, and therapy-decision purposes for patients with certain cancers, particularly pancreatic, lung, and colorectal cancers. The analysis of the KRAS gene in exon 2 can provide valuable information about the patient’s condition and guide treatment decisions.

5. When to use CPT code 81275

CPT code 81275 should be used when there is a need to analyze the KRAS gene for common changes in exon 2, specifically variants in codons 12 and 13. This code is appropriate when the analysis is performed to aid in the diagnosis, prognosis, or treatment decisions for patients with certain cancers.

6. Documentation requirements

To support a claim for CPT 81275, the documentation should include:

• Indication for the test, such as the suspected cancer type or the need for therapy decision-making
• Details of the technical steps performed, including nucleic acid extraction, amplification, and detection
• Results of the analysis, specifically noting any variants in codons 12 and 13 of the KRAS gene
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81275, ensure that the analysis is performed for the detection of common changes in the KRAS gene in exon 2. It is important to follow the specific documentation requirements and guidelines provided by the payer. Additionally, consider reporting any additional prep work or interpretation services, if applicable, using the appropriate codes and modifiers.

8. Historical information

CPT 81275 was added to the Current Procedural Terminology system on January 1, 2012. The code was later revised on January 1, 2016, to specify the analysis of variants in codons 12 and 13 of the KRAS gene in exon 2.

9. Examples

1. A patient with suspected pancreatic cancer undergoes analysis of the KRAS gene in exon 2 to determine if there are any variants in codons 12 and 13.
2. A lung cancer patient’s sample is analyzed to identify any common changes in the KRAS gene in exon 2, specifically in codons 12 and 13.
3. A colorectal cancer patient’s sample is tested for variants in codons 12 and 13 of the KRAS gene in exon 2 to guide treatment decisions.
4. A clinician orders the analysis of the KRAS gene in exon 2 for a patient with an unknown primary cancer site to help identify the origin of the cancer.
5. A patient with a family history of cancer undergoes analysis of the KRAS gene in exon 2 to assess their risk of developing certain cancers.
6. A clinician orders the analysis of the KRAS gene in exon 2 for a patient with a suspected hereditary cancer syndrome.
7. A patient with a history of lung cancer undergoes analysis of the KRAS gene in exon 2 to monitor for any recurrence or treatment response.
8. A clinician orders the analysis of the KRAS gene in exon 2 for a patient with metastatic colorectal cancer to guide targeted therapy decisions.
9. A patient with a suspicious lung nodule undergoes analysis of the KRAS gene in exon 2 to determine if it is cancerous.
10. A clinician orders the analysis of the KRAS gene in exon 2 for a patient with a positive family history of pancreatic cancer.