How To Use CPT Code 81296

CPT 81296 describes the analysis of the MSH2 gene, also known as the colon cancer or nonpolyposis type 1 gene, to detect known familial variants. 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 81296?

CPT 81296 can be used to analyze the MSH2 gene for known familial variants. This test is performed by a lab analyst to detect mutations that have been previously identified in the patient’s family members. The MSH2 gene is associated with conditions such as Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, which increases the risk of colorectal, endometrial, ovarian, and urinary and biliary tract cancers.

2. Official Description

The official description of CPT code 81296 is: ‘MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (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 MSH2 gene for known familial variants.
2. This includes extracting nucleic acids, such as DNA or RNA, from the patient’s sample.
3. The lab analyst then amplifies and stabilizes the quantity of nucleic acid for analysis.
4. Specific parts of the MSH2 gene that harbor known mutations are analyzed using methods such as nucleic acid probes.
5. The lab analyst detects and identifies the presence of the known familial variants in the patient’s MSH2 gene.

4. Qualifying circumstances

CPT 81296 is used when clinicians order the analysis of the MSH2 gene for known familial variants. This test is commonly ordered for patients with familial MSH2 mutations to assist in diagnosis or determine carrier status for Lynch syndrome. It is important to note that CPT 81296 is specifically for analyzing known variants and should not be used for full sequence analysis or MSH2 duplication/deletion variants.

5. When to use CPT code 81296

CPT code 81296 should be used when the lab analyst performs the analysis of the MSH2 gene for known familial variants. It is important to ensure that the test is specifically for the MSH2 gene and not for other genes associated with Lynch syndrome. If analysis of both the MSH2 and MLH1 genes is ordered, separate codes should be used for each gene.

6. Documentation requirements

To support a claim for CPT 81296, documentation should include:

• Indication of the need for analysis of the MSH2 gene for known familial variants
• Details of the technical steps performed by the lab analyst
• Identification of the specific known familial variants analyzed
• Date and time of the analysis
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81296, ensure that the analysis is specifically for known familial variants of the MSH2 gene. If the ordering clinician separately requests physician interpretation of the test, it may be appropriate to report an additional code for the interpretation. It is important to use the appropriate codes for full sequence analysis or MSH2 duplication/deletion variants, if applicable.

8. Historical information

CPT 81296 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 MSH2 gene for known familial variants in a patient with a family history of Lynch syndrome.
2. The MSH2 gene analysis is ordered for a patient to determine their carrier status for hereditary nonpolyposis colorectal cancer.
3. A patient with a known MSH2 gene mutation undergoes testing to assess their risk for other malignancies associated with Lynch syndrome.
4. The lab analyst analyzes the MSH2 gene for known familial variants in a patient with a family history of colorectal cancer.
5. A clinician orders the analysis of the MSH2 gene for known familial variants to assist in the diagnosis of Lynch syndrome in a patient with multiple cancer diagnoses.
6. A patient with a family history of Lynch syndrome undergoes MSH2 gene analysis to determine their risk for developing associated cancers.
7. The lab analyst performs the analysis of the MSH2 gene for known familial variants in a patient with a family history of endometrial cancer.
8. A patient with a known MSH2 gene mutation undergoes testing to assess their risk for urinary and biliary tract cancers associated with Lynch syndrome.
9. The MSH2 gene analysis is ordered for a patient with a family history of Lynch syndrome to determine their carrier status for hereditary nonpolyposis colorectal cancer.
10. A clinician orders the analysis of the MSH2 gene for known familial variants in a patient with a family history of ovarian cancer.