How To Use CPT Code 81276

CPT 81276 describes the genetic analysis procedure for the KRAS gene, specifically detecting additional variants other than in exon 2, such as codons 61 or 146. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81276?

CPT 81276 can be used to describe the genetic analysis procedure for the KRAS gene, focusing on the detection of additional variants in locations other than exon 2, such as codons 61 or 146. This code is used when the lab analyst performs the technical steps to identify these variants, which are associated with uncontrolled cell growth and cancer.

2. Official Description

The official description of CPT code 81276 is: ‘KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146).’ This code represents the testing for changes in the KRAS gene, specifically variants found in locations other than exon 2.

3. Procedure

1. The lab analyst performs the technical steps of the genetic analysis procedure for the KRAS gene.
2. This includes extracting nucleic acids, amplifying the gene, and detecting the target genes using methods such as nucleic acid probes.
3. The focus is on identifying additional variants in locations other than exon 2, such as codons 61 or 146.
4. The procedure helps in understanding the presence of genetic errors that may lead to uncontrolled cell growth and cancer.

4. Qualifying circumstances

CPT 81276 is used when there is a need to detect additional variants in the KRAS gene, specifically in locations other than exon 2. This procedure is often ordered following testing for KRAS exon 2 variants for prognostic and therapy-decision purposes, especially in patients with certain cancers like colorectal cancer. The variants in exon 3 codons 61 and 146 may indicate resistance to cetuximab plus irinotecan for certain subsets of colorectal cancer patients.

5. When to use CPT code 81276

CPT code 81276 should be used when there is a specific need to analyze the KRAS gene for additional variants in locations other than exon 2, such as codons 61 or 146. It is important to note that this code should not be used for full gene sequence analysis for KRAS or for variants in exon 2, as there are separate codes for those specific tests.

6. Documentation requirements

To support a claim for CPT 81276, documentation should include:

• Indication of the need for genetic analysis of the KRAS gene
• Specific variants being tested for, such as codons 61 or 146
• Date and time of the procedure
• Details of the technical steps performed by the lab analyst
• Results of the analysis and any relevant interpretations
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81276, ensure that the procedure is performed to detect additional variants in the KRAS gene, specifically in locations other than exon 2. It is important to note that this code should not be reported for full gene sequence analysis or for variants in exon 2. Additionally, there may be separate codes for prep work preceding the procedure, and if physician interpretation and report are separately requested, an additional code may be applicable.

8. Historical information

CPT 81276 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the genetic analysis procedure for the KRAS gene to detect additional variants in codon 61 for a patient with colorectal cancer.
2. An oncologist ordering the genetic analysis procedure for the KRAS gene to determine resistance to cetuximab plus irinotecan in a subset of colorectal cancer patients with variants in codon 146.
3. A pathologist interpreting the results of the genetic analysis procedure for the KRAS gene and providing a report for a patient with suspected genetic disorders.
4. A lab analyst performing the genetic analysis procedure for the KRAS gene to detect additional variants in codon 61 for a patient with pancreatic cancer.
5. An oncologist ordering the genetic analysis procedure for the KRAS gene to guide therapy decisions for a patient with lung cancer and variants in codon 146.
6. A pathologist interpreting the results of the genetic analysis procedure for the KRAS gene and providing a report for a patient with suspected hereditary cancer syndrome.
7. A lab analyst performing the genetic analysis procedure for the KRAS gene to detect additional variants in codon 61 for a patient with ovarian cancer.
8. An oncologist ordering the genetic analysis procedure for the KRAS gene to determine the prognosis for a patient with colorectal cancer and variants in codon 146.
9. A pathologist interpreting the results of the genetic analysis procedure for the KRAS gene and providing a report for a patient with suspected familial adenomatous polyposis.
10. A lab analyst performing the genetic analysis procedure for the KRAS gene to detect additional variants in codon 61 for a patient with melanoma.