How To Use CPT Code 81298

CPT 81298 describes the full sequence analysis of the MSH6 gene, which is used for the diagnosis of Lynch syndrome or hereditary nonpolyposis 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 81298?

CPT 81298 is a code used to describe the full sequence analysis of the MSH6 gene. This test is performed by a lab analyst to analyze the entire gene sequence of the mutS homolog 6 [E. coli] gene. It is commonly ordered by clinicians for the diagnosis of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer. This test helps to evaluate the inheritance of genetic mutations in the MSH6 gene and assess the risk of other malignancies such as endometrial, ovarian, and urinary and biliary tract cancers.

2. Official Description

The official description of CPT code 81298 is: ‘MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis.’

3. Procedure

1. The lab analyst performs all technical steps required for the full sequence analysis of the MSH6 gene.
2. This includes extracting nucleic acids from the sample, amplifying the quantity of nucleic acid for analysis, and detecting the target genes using methods such as nucleic acid probes.
3. The full gene sequence analysis involves analyzing the entire sequence of the MSH6 gene, not just evaluating common variants.

4. Qualifying circumstances

CPT 81298 is typically ordered by clinicians when there is a suspicion of Lynch syndrome or hereditary nonpolyposis colorectal cancer. It is used to evaluate the presence of genetic mutations in the MSH6 gene and assess the risk of other associated malignancies. The test is not limited to testing for a specific condition and can be ordered for various clinical indications.

5. When to use CPT code 81298

CPT code 81298 should be used when the lab analyst performs the full sequence analysis of the MSH6 gene. This code is specifically for analyzing the entire gene sequence, not just evaluating common variants. If the test is performed to analyze known familial variants of MSH6, CPT code 81299 should be used. For MSH6 duplication/deletion variants, CPT code 81300 is appropriate.

6. Documentation requirements

To support a claim for CPT code 81298, the documentation should include:

• Indication for the test, such as suspicion of Lynch syndrome or hereditary nonpolyposis colorectal cancer
• Details of the technical steps performed by the lab analyst, including nucleic acid extraction, amplification, and detection methods
• Confirmation that the full sequence analysis of the MSH6 gene was performed

7. Billing guidelines

When billing for CPT code 81298, ensure that the full sequence analysis of the MSH6 gene was performed by the lab analyst. It is important to note that this code should not be reported with other codes for testing common variants or duplication/deletion variants of MSH6. Additional codes may be used for prep work preceding the analysis, such as tissue selection or microdissection, if documented separately. If the ordering clinician requests physician interpretation of the test and the pathologist provides an interpretation and report, modifier 26 should be appended to CPT code 81298 when reporting to Medicare and potentially other payers.

8. Historical information

CPT code 81298 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs the full sequence analysis of the MSH6 gene for a patient suspected of having Lynch syndrome.
2. A clinician orders CPT code 81298 to evaluate the inheritance of genetic mutations in the MSH6 gene for a patient with a family history of hereditary nonpolyposis colorectal cancer.
3. A lab analyst analyzes the entire gene sequence of MSH6 to assess the risk of other malignancies, such as endometrial, ovarian, and urinary and biliary tract cancers, for a patient with a known MSH6 gene mutation.
4. A clinician orders CPT code 81298 to confirm the presence of genetic mutations in the MSH6 gene for a patient with suspected Lynch syndrome, after testing for MLH1 and MSH2 gene mutations came back negative.
5. A lab analyst performs the full sequence analysis of the MSH6 gene to evaluate the risk of Lynch syndrome in a patient with a personal history of colorectal cancer and a family history of Lynch syndrome.
6. A clinician orders CPT code 81298 to assess the risk of hereditary nonpolyposis colorectal cancer in a patient with a known MSH6 gene mutation.
7. A lab analyst analyzes the entire gene sequence of MSH6 to evaluate the risk of Lynch syndrome in a patient with a family history of the condition.
8. A clinician orders CPT code 81298 to determine the presence of genetic mutations in the MSH6 gene for a patient with a personal history of endometrial cancer and a family history of Lynch syndrome.
9. A lab analyst performs the full sequence analysis of the MSH6 gene to assess the risk of other malignancies, such as ovarian and urinary and biliary tract cancers, in a patient with a known MSH6 gene mutation.