How To Use CPT Code 81343

CPT 81343 describes the analysis of the PPP2R2B gene to detect abnormal alleles, specifically expanded sequences. 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 81343?

CPT 81343 can be used to analyze the PPP2R2B gene for the detection of abnormal alleles, particularly expanded sequences. This test is performed to identify changes in the protein phosphatase 2 regulatory subunit Bbeta (PPP2R2B) gene that may be associated with certain conditions, such as spinocerebellar ataxia.

2. Official Description

The official description of CPT code 81343 is: ‘PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles.’

3. Procedure

1. The lab analyst performs the technical steps of the PPP2R2B gene analysis, starting with the extraction of nucleic acids from a specimen, such as blood.
2. The extracted nucleic acids are then amplified using a method like polymerase chain reaction (PCR) to increase their quantity for analysis.
3. The lab analyst detects the presence of abnormal alleles, specifically expanded sequences, in the PPP2R2B gene.

4. Qualifying circumstances

CPT 81343 is typically ordered by clinicians to aid in the diagnosis of spinocerebellar ataxia 12 (SCA12), a heritable disease characterized by tremors and poor coordination. It may also be used to determine carrier status for certain conditions. The test is performed on individuals suspected of having abnormalities in the PPP2R2B gene.

5. When to use CPT code 81343

CPT code 81343 should be used when analyzing the PPP2R2B gene to detect abnormal alleles, specifically expanded sequences. It is appropriate to bill this code when the test is performed to aid in the diagnosis of spinocerebellar ataxia or to determine carrier status for certain conditions.

6. Documentation requirements

To support a claim for CPT 81343, documentation should include:

• Reason for ordering the test, such as suspicion of spinocerebellar ataxia or carrier status determination
• Details of the technical steps performed, including specimen extraction, amplification method used, and detection of abnormal alleles
• Results of the analysis, indicating the presence or absence of expanded sequences in the PPP2R2B gene

7. Billing guidelines

When billing for CPT 81343, ensure that the test is performed to analyze the PPP2R2B gene for the detection of abnormal alleles. It is important to note that some payers may separately reimburse for specimen collection using a code like 36415. If the ordering clinician requests physician interpretation of the test and the pathologist provides an interpretation and report, you may also report G0452 with modifier 26 to Medicare and other payers, as long as an MD or DO physician performs the interpretation.

8. Historical information

CPT 81343 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient suspected of having spinocerebellar ataxia undergoes analysis of the PPP2R2B gene to detect expanded sequences.
2. A couple undergoes carrier status testing for spinocerebellar ataxia using the PPP2R2B gene analysis.
3. A patient with symptoms of tremors and poor coordination undergoes analysis of the PPP2R2B gene to aid in the diagnosis of spinocerebellar ataxia.
4. A family with a history of spinocerebellar ataxia undergoes PPP2R2B gene analysis to determine carrier status.
5. A patient with an abnormal neurological examination undergoes analysis of the PPP2R2B gene to investigate the possibility of spinocerebellar ataxia.
6. A clinician orders PPP2R2B gene analysis to rule out spinocerebellar ataxia in a patient with unexplained coordination problems.
7. A patient with a family history of spinocerebellar ataxia undergoes analysis of the PPP2R2B gene to determine their carrier status.
8. A patient with symptoms suggestive of spinocerebellar ataxia undergoes PPP2R2B gene analysis to aid in the diagnosis.
9. A clinician orders PPP2R2B gene analysis to investigate the cause of a patient’s tremors and poor coordination.
10. A patient with a known PPP2R2B gene mutation undergoes analysis to monitor the expansion of the abnormal allele.