How To Use CPT Code 81288

CPT 81288 describes the genetic analysis procedure known as MLH1 gene analysis, specifically focusing on promoter methylation analysis. 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 81288?

CPT 81288 is a genetic analysis procedure that involves the analysis of the MLH1 gene, also known as the mutL homolog 1 gene. Specifically, this code focuses on promoter methylation analysis, which detects changes in the MLH1 gene related to conditions such as hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome.

2. Official Description

The official description of CPT code 81288 is: ‘MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis.’

3. Procedure

1. The lab analyst performs various technical steps to analyze the MLH1 gene, including promoter methylation analysis.
2. This involves extracting nucleic acids from the sample, such as through cell lysis and digestion.
3. The lab analyst then amplifies and stabilizes the quantity of nucleic acid for analysis.
4. Next, the lab analyst attaches methyl groups to the bases in the MLH1 gene to assess genetic changes related to conditions such as Lynch syndrome.
5. Finally, the lab analyst detects the target genes using methods such as nucleic acid probes.

4. Qualifying circumstances

CPT 81288 is commonly ordered by clinicians for the diagnosis of Lynch syndrome, a hereditary condition that increases the risk of colorectal and other types of cancer. It may also be ordered to evaluate the inheritance of genetic mutations in the MLH1 gene. Promoter methylation analysis can help identify sporadic tumors rather than hereditary tumors.

5. When to use CPT code 81288

CPT code 81288 should be used when performing promoter methylation analysis of the MLH1 gene. It is appropriate when there is a clinical need to assess genetic changes related to conditions such as Lynch syndrome. This code should not be used for full sequence analysis of the MLH1 gene or for analyzing known familial variants, as separate codes exist for these procedures.

6. Documentation requirements

To support a claim for CPT 81288, documentation should include:

• Indication for the test, such as suspicion of Lynch syndrome or evaluation of MLH1 gene mutations
• Details of the technical steps performed, including promoter methylation analysis
• Date and time of the analysis
• Results of the analysis and any relevant genetic changes identified
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81288, ensure that the procedure performed is promoter methylation analysis of the MLH1 gene. It is important to follow the specific documentation requirements and guidelines provided by the payer. It is also important to note that separate codes exist for other types of MLH1 gene analysis, such as full sequence analysis or analysis of known familial variants.

8. Historical information

CPT 81288 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing promoter methylation analysis of the MLH1 gene to detect genetic changes related to Lynch syndrome.
2. A clinician ordering CPT 81288 to evaluate the inheritance of MLH1 gene mutations in a patient with a family history of colorectal cancer.
3. A lab technician conducting promoter methylation analysis to identify sporadic tumors in a patient with suspected hereditary nonpolyposis colorectal cancer.
4. A genetic counselor recommending CPT 81288 to assess the risk of Lynch syndrome in a patient with a personal history of endometrial cancer.
5. A pathologist performing promoter methylation analysis of the MLH1 gene to differentiate between hereditary and sporadic tumors in a patient with biliary tract cancer.
6. A researcher using CPT 81288 to analyze the MLH1 gene for a study on the genetic changes associated with Lynch syndrome.
7. A clinician ordering promoter methylation analysis of the MLH1 gene to confirm the diagnosis of Lynch syndrome in a patient with a family history of colorectal and ovarian cancer.
8. A lab analyst performing promoter methylation analysis to assess the risk of Lynch syndrome in a patient with urinary tract cancer.
9. A geneticist recommending CPT 81288 to evaluate the MLH1 gene for potential mutations in a patient with a family history of Lynch syndrome.
10. A pathologist conducting promoter methylation analysis of the MLH1 gene to identify genetic changes in a patient with suspected hereditary nonpolyposis colorectal cancer.