How To Use CPT Code 81295

CPT 81295 describes the full sequence analysis of the MSH2 gene, also known as the colon cancer or nonpolyposis type 1 gene. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81295?

CPT 81295 can be used to describe the full sequence analysis of the MSH2 gene, which is associated with conditions such as hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome. This code is used when the lab analyst performs the technical steps to analyze the entire gene sequence of MSH2, not just evaluating common variants.

2. Official Description

The official description of CPT code 81295 is: ‘MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis.’

3. Procedure

1. The lab analyst performs all technical steps, from extracting the nucleic acids to detecting the target genes, to analyze the full gene sequence of MSH2.

4. Qualifying circumstances

CPT 81295 is commonly ordered for the diagnosis of Lynch syndrome, which increases the risk of colorectal, endometrial, ovarian, and urinary and biliary tract cancers. It may also be ordered to evaluate inheritance of genetic mutations in the MSH2 gene.

5. When to use CPT code 81295

CPT code 81295 should be used when the lab analyst performs the full gene sequence analysis of MSH2. It should not be used for testing known familial variants or duplication/deletion variants of MSH2.

6. Documentation requirements

To support a claim for CPT 81295, documentation should include the specific details of the technical steps performed by the lab analyst, such as nucleic acid extraction, amplification, and detection. The ordering clinician may also separately request physician interpretation of the test, which can be reported with modifier 26.

7. Billing guidelines

When billing for CPT 81295, ensure that the lab analyst performs the full gene sequence analysis of MSH2. If the test includes analysis of both MSH2 and MLH1 genes, separate codes should be reported for each gene. It is important to follow the specific guidelines of each payer when reporting this code.

8. Historical information

CPT 81295 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 performing the full sequence analysis of the MSH2 gene for a patient with a family history of Lynch syndrome.
2. An oncologist ordering the full gene sequence analysis of MSH2 and MLH1 genes for a patient with suspected hereditary nonpolyposis colorectal cancer.
3. A genetic counselor requesting the full sequence analysis of the MSH2 gene to evaluate inheritance of genetic mutations in a family.
4. A pathologist interpreting the results of the full sequence analysis of the MSH2 gene and providing a report for further clinical management.
5. A researcher studying the MSH2 gene and performing the full sequence analysis to identify novel variants.
6. A surgeon ordering the full gene sequence analysis of MSH2 for a patient with multiple primary tumors.
7. A gastroenterologist requesting the full sequence analysis of the MSH2 gene to assess the risk of colorectal cancer in a patient.
8. A geneticist analyzing the full gene sequence of MSH2 to identify potential therapeutic targets for Lynch syndrome.
9. A hematologist ordering the full sequence analysis of the MSH2 gene to investigate the association with hematologic malignancies.
10. A pathologist performing the technical steps for the full sequence analysis of the MSH2 gene and collaborating with other healthcare professionals for comprehensive patient management.