How To Use CPT Code 81291

CPT 81291 describes the analysis of the MTHFR gene for common variants, such as 677T and 1298C, which are associated with hereditary hypercoagulability. 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 81291?

CPT 81291 can be used to analyze the MTHFR gene for common variants, specifically 677T and 1298C. This test is performed to detect the presence of these variants, which are associated with hereditary hypercoagulability. The analysis is conducted by a lab analyst using various technical steps, such as nucleic acid extraction, amplification, and target gene detection.

2. Official Description

The official description of CPT code 81291 is: ‘MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C).’ This code represents the testing for common changes in the MTHFR gene, including the variants 677T and 1298C, which are associated with hereditary hypercoagulability.

3. Procedure

1. The lab analyst performs technical steps to analyze the MTHFR gene for common variants.
2. This includes extracting nucleic acids, amplifying the target gene, and detecting the presence of the variants.
3. The analysis may also include other non-listed variants in addition to 677T and 1298C.

4. Qualifying circumstances

CPT 81291 is typically ordered for individuals with elevated homocysteine levels or a family history of known MTHFR mutation and/or early-onset cardiovascular disease. Elevated homocysteine levels related to MTHFR mutations are associated with conditions that can lead to heart disease, such as hyperlipidemia, hypertension, and atherosclerosis.

5. When to use CPT code 81291

CPT code 81291 should be used when there is a clinical need to analyze the MTHFR gene for common variants, specifically 677T and 1298C. It is typically ordered for individuals with elevated homocysteine levels or a family history of known MTHFR mutation and/or early-onset cardiovascular disease.

6. Documentation requirements

To support a claim for CPT 81291, the documentation should include:

• Reason for ordering the test, such as elevated homocysteine levels or family history of MTHFR mutation
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including the presence or absence of the common variants
• Interpretation of the test results, if separately requested by the ordering clinician and performed by an MD or DO physician

7. Billing guidelines

When billing for CPT 81291, ensure that the analysis is performed for the common variants in the MTHFR gene. It is important to note that separate reporting of prep work, such as tissue selection or microdissection, may be necessary in certain cases. If the ordering clinician requests separate physician interpretation, it can be reported using code G0452 with modifier 26.

8. Historical information

CPT 81291 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. An individual with elevated homocysteine levels undergoes the analysis of the MTHFR gene for common variants 677T and 1298C.
2. A patient with a family history of known MTHFR mutation and early-onset cardiovascular disease receives the analysis of the MTHFR gene for common variants.
3. A clinician orders the analysis of the MTHFR gene for common variants 677T and 1298C in a patient with hyperlipidemia.
4. An individual with hypertension undergoes the analysis of the MTHFR gene for common variants associated with hereditary hypercoagulability.
5. A patient with atherosclerosis receives the analysis of the MTHFR gene for common variants 677T and 1298C.
6. A clinician orders the analysis of the MTHFR gene for common variants in a patient with a family history of early-onset cardiovascular disease.
7. An individual with elevated homocysteine levels undergoes the analysis of the MTHFR gene for common variants associated with hereditary hypercoagulability.
8. A patient with hyperlipidemia receives the analysis of the MTHFR gene for common variants 677T and 1298C.
9. An individual with hypertension undergoes the analysis of the MTHFR gene for common variants in order to assess their risk of hereditary hypercoagulability.
10. A clinician orders the analysis of the MTHFR gene for common variants in a patient with a family history of atherosclerosis.