How To Use CPT Code 81293

CPT 81293 describes the analysis of the MLH1 gene for known familial variants, specifically those associated with conditions such as Lynch syndrome or nonpolyposis type 2 colorectal cancer. 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 81293?

CPT 81293 involves the analysis of the MLH1 gene for known familial variants. This test is commonly ordered by clinicians to identify specific mutations in the MLH1 gene that have been identified in the patient’s family members. The presence of these mutations can be indicative of conditions such as Lynch syndrome or nonpolyposis type 2 colorectal cancer. The analysis focuses on specific parts of the MLH1 gene that harbor these known variants.

2. Official Description

The official description of CPT code 81293 is: ‘MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants.’

3. Procedure

1. The lab analyst performs technical steps to analyze the MLH1 gene for known familial variants.
2. This includes extracting nucleic acids from the patient’s sample, such as through cell lysis and digestion.
3. The lab analyst then amplifies and stabilizes the quantity of nucleic acid for analysis.
4. The target genes, specifically the MLH1 gene, are detected using methods such as nucleic acid probes.
5. The analysis focuses on specific parts of the MLH1 gene that have been previously identified as harboring known familial variants.

4. Qualifying circumstances

CPT 81293 is used when clinicians order the analysis of the MLH1 gene for known familial variants. This test is commonly performed to identify specific mutations in the MLH1 gene that have been identified in the patient’s family members. It is often ordered as a family-member predictive test for conditions such as Lynch syndrome or nonpolyposis type 2 colorectal cancer. The presence of these mutations increases the patient’s risk of developing various malignancies, including colorectal, endometrial, ovarian, and urinary and biliary tract cancers.

5. When to use CPT code 81293

CPT code 81293 should be used when the lab analyst performs the analysis of the MLH1 gene for known familial variants. This code is specifically for analyzing parts of the MLH1 gene that have been previously identified as harboring these variants. If a full sequence analysis of the MLH1 gene is performed, CPT code 81292 should be used. For MLH1 duplication/deletion variants, CPT code 81294 is appropriate.

6. Documentation requirements

To support a claim for CPT code 81293, the documentation should include:

• Indication of the need for analysis of the MLH1 gene for known familial variants
• Specific parts of the MLH1 gene analyzed
• Date and time of the analysis
• Results of the analysis, including the presence or absence of known familial variants
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 81293, ensure that the analysis is specifically for known familial variants of the MLH1 gene. If the ordering clinician requests physician interpretation of the test and the pathologist provides an interpretation and report, CPT code G0452 with modifier 26 may be additionally reported. It is important to note that an MD or DO physician must perform the interpretation. If analysis of both the MLH1 and MSH2 genes is ordered, separate codes should be reported for each gene.

8. Historical information

CPT code 81293 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. A lab analyst performs the analysis of the MLH1 gene for known familial variants in a patient with a family history of Lynch syndrome.
2. The MLH1 gene is analyzed for specific mutations that have been identified in the patient’s family members, indicating an increased risk of colorectal cancer.
3. Analysis of the MLH1 gene is performed to confirm the presence of known familial variants associated with nonpolyposis type 2 colorectal cancer.
4. A patient with a family history of Lynch syndrome undergoes analysis of the MLH1 gene to identify specific mutations that may increase their risk of developing various malignancies.
5. The lab analyst analyzes the MLH1 gene for known familial variants in a patient with a family history of urinary and biliary tract cancers.
6. Analysis of the MLH1 gene is performed to identify specific mutations associated with Lynch syndrome in a patient with a family history of endometrial cancer.
7. A lab analyst performs the analysis of the MLH1 gene for known familial variants in a patient with a family history of nonpolyposis type 2 colorectal cancer.
8. The MLH1 gene is analyzed to detect specific mutations that may increase the patient’s risk of developing ovarian cancer.
9. Analysis of the MLH1 gene is performed to identify known familial variants associated with Lynch syndrome in a patient with a family history of colorectal cancer.
10. A patient with a family history of nonpolyposis type 2 colorectal cancer undergoes analysis of the MLH1 gene to confirm the presence of specific mutations.