How To Use CPT Code 81351

CPT 81351 describes the analysis of the full gene sequence for the tumor protein 53 (TP53) gene, which can indicate a diagnosis of Li-Fraumeni syndrome. 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 81351?

CPT 81351 can be used to analyze the entire gene sequence of the TP53 gene, which is responsible for producing the tumor protein 53. This analysis is crucial in diagnosing conditions such as Li-Fraumeni syndrome, which is an inherited condition associated with early onset of multiple cancers. By examining the full gene sequence, healthcare professionals can identify any mutations in the TP53 gene that may contribute to the development of cancer.

2. Official Description

The official description of CPT code 81351 is: ‘TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence.’

3. Procedure

1. The lab analyst performs technical steps to analyze the full gene sequence of the TP53 gene using a specimen, such as blood.
2. The process involves extracting nucleic acids from the specimen, increasing and stabilizing the quantity of nucleic acid for analysis, and detecting the target genes.
3. A single unit of CPT 81351 represents the analysis of the full gene sequence for TP53.

4. Qualifying circumstances

CPT 81351 is typically ordered by clinicians to evaluate germline mutations and confirm a suspected diagnosis of Li-Fraumeni syndrome. Germline mutations occur in reproductive cells and can be inherited by offspring, leading to the mutation occurring in all of the child’s cells. The analysis of the TP53 gene can help identify familial mutations, indicating the need for predictive testing for family members. Mutations in the TP53 gene can contribute to uncontrolled cell growth and the development of various types of cancer.

5. When to use CPT code 81351

CPT code 81351 should be used when there is a need to analyze the full gene sequence of the TP53 gene to evaluate for the presence of mutations associated with conditions like Li-Fraumeni syndrome. It is important to note that this code should not be reported if the analysis is part of a gene panel test that includes TP53.

6. Documentation requirements

To support a claim for CPT 81351, documentation should include:

• Indication of the need for TP53 gene analysis
• Details of the technical steps performed during the analysis
• Specimen used for analysis
• Results of the analysis, including any identified mutations
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81351, ensure that the analysis of the full gene sequence for the TP53 gene is performed. It is important to distinguish between CPT codes 81351, 81352 (targeted sequence analysis), and 81353 (known familial variants). If the ordering clinician requests physician interpretation of the test, an additional code, such as G0452 with modifier 26, may be reported. It is also essential to consider any separate codes for specimen collection or tissue processing, if applicable.

8. Historical information

CPT 81351 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing the analysis of the full gene sequence for the TP53 gene to evaluate for the presence of mutations associated with Li-Fraumeni syndrome.
2. An oncologist ordering CPT 81351 to confirm a suspected diagnosis of Li-Fraumeni syndrome in a patient with a family history of multiple cancers.
3. A genetic counselor recommending TP53 gene analysis for a patient with a personal or family history of early-onset cancers.
4. A pathologist interpreting the results of CPT 81351 and providing a report to the ordering clinician for further evaluation and treatment planning.
5. A researcher conducting a study on the prevalence of TP53 gene mutations in a specific population.
6. A physician ordering TP53 gene analysis to assess the risk of developing cancer in a patient with a known TP53 mutation.
7. A patient undergoing TP53 gene analysis as part of a comprehensive genetic testing panel for hereditary cancer syndromes.
8. A geneticist using CPT 81351 to identify TP53 gene mutations in a family with a history of Li-Fraumeni syndrome.
9. A surgeon considering TP53 gene analysis to guide treatment decisions for a patient with a suspected diagnosis of Li-Fraumeni syndrome.
10. A pediatrician ordering TP53 gene analysis for a child with a family history of early-onset cancers to assess the risk of Li-Fraumeni syndrome.