How To Use CPT Code 81315

CPT 81315 describes the genetic analysis procedure for evaluating the presence and/or amount of the PML/RARalpha mutation gene, specifically the common breakpoints in the gene sequence. 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 81315?

CPT 81315 can be used to describe the genetic analysis procedure performed by a laboratory analyst to evaluate the presence and/or amount of the PML/RARalpha mutation gene. This gene, formed from common breakpoints in the gene sequence, is associated with promyelocytic leukemia/retinoic acid receptor alpha (PML/RARalpha). The analysis can be qualitative or quantitative, providing information about the fusion gene and its relative quantity.

2. Official Description

The official description of CPT code 81315 is: ‘PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative.’

3. Procedure

1. The laboratory analyst performs the technical steps of the genetic analysis procedure.
2. This includes extracting nucleic acids from the sample, such as through cell lysis and digestion.
3. The analyst then amplifies and stabilizes the quantity of nucleic acid for analysis.
4. Next, the target DNA sequence is detected, specifically evaluating the common breakpoints involved in the formation of the fusion gene PML/RARalpha, (t(15;17)).
5. The relative quantity of the target gene sequences is measured, providing information about the presence and/or amount of the mutation gene.

4. Qualifying circumstances

CPT 81315 is typically ordered by clinicians to help diagnose acute promyelocytic leukemia, a condition characterized by the accumulation of promyelocytes in the bone marrow and the production of the abnormal PML/RARalpha protein. However, the test is not limited to this specific condition and can be used to evaluate the presence and/or amount of the PML/RARalpha mutation gene in other scenarios as well.

5. When to use CPT code 81315

CPT code 81315 should be used when there is a need to analyze the common breakpoints involved in the formation of the fusion gene PML/RARalpha, (t(15;17)). This code is appropriate for both qualitative and quantitative analysis of the mutation gene. It is important to distinguish between CPT code 81315 and CPT code 81316, as the former includes evaluation of both intron 3 and intron 6 breakpoints, while the latter only evaluates one of these breakpoints.

6. Documentation requirements

To support a claim for CPT code 81315, documentation should include:

• Indication of the need for the genetic analysis procedure
• Details of the specific breakpoints evaluated, including intron 3 and intron 6
• Date and time of the procedure
• Results of the analysis, whether qualitative or quantitative
• Signature of the laboratory analyst performing the procedure

7. Billing guidelines

When billing for CPT code 81315, ensure that the procedure is performed by a laboratory analyst. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. Additionally, be aware of any other codes that may need to be reported in conjunction with CPT code 81315, depending on the specific circumstances and payer requirements.

8. Historical information

CPT code 81315 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 laboratory analyst performing the genetic analysis procedure to evaluate the presence and amount of the PML/RARalpha mutation gene in a patient with suspected acute promyelocytic leukemia.
2. A clinician ordering CPT code 81315 to assess the common breakpoints involved in the formation of the fusion gene PML/RARalpha, (t(15;17)), in a patient with atypical symptoms.
3. A laboratory analyst conducting the genetic analysis procedure to determine the relative quantity of the PML/RARalpha mutation gene in a patient undergoing treatment for promyelocytic leukemia.
4. A clinician utilizing CPT code 81315 to evaluate the presence of the PML/RARalpha mutation gene in a patient with a family history of promyelocytic leukemia.
5. A laboratory analyst performing the genetic analysis procedure to assess the common breakpoints involved in the formation of the fusion gene PML/RARalpha, (t(15;17)), in a patient with unexplained abnormal blood cell counts.
6. A clinician ordering CPT code 81315 to determine the amount of the PML/RARalpha mutation gene in a patient with a suspected relapse of promyelocytic leukemia.
7. A laboratory analyst conducting the genetic analysis procedure to evaluate the presence and relative quantity of the PML/RARalpha mutation gene in a patient with a known history of promyelocytic leukemia.
8. A clinician utilizing CPT code 81315 to assess the common breakpoints involved in the formation of the fusion gene PML/RARalpha, (t(15;17)), in a patient with persistent symptoms despite previous treatment for promyelocytic leukemia.