How To Use CPT Code 81361

CPT 81361 describes the genetic analysis procedure for detecting specific changes in the hemoglobin, subunit beta (HBB) gene, specifically for common variants such as HbS, HbC, and HbE. 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 81361?

CPT 81361 can be used to describe the genetic analysis procedure performed to detect specific changes in the HBB gene, specifically for common variants like HbS, HbC, and HbE. This code is used when the lab analyst performs the technical steps involved in the analysis, from extracting nucleic acids to detecting the target genes using a specimen such as blood.

2. Official Description

The official description of CPT code 81361 is: ‘HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)’

3. Procedure

1. The lab analyst performs the technical steps involved in the genetic analysis procedure.
2. This includes extracting nucleic acids from the specimen, amplifying the gene of interest, and detecting the target genes using methods such as nucleic acid probes.
3. The analysis specifically focuses on detecting common variants of the HBB gene, such as HbS, HbC, and HbE.

4. Qualifying circumstances

CPT 81361 is used when clinicians order the genetic analysis procedure to evaluate genetic carrier status or confirm suspected HbS, HbC, or HbE mutations associated with conditions like sickle cell disease. The analysis helps identify changes in the HBB gene that may lead to structural and functional alterations in hemoglobin.

5. When to use CPT code 81361

CPT code 81361 should be used when the lab analyst performs the genetic analysis procedure to detect common variants of the HBB gene, such as HbS, HbC, and HbE. It is important to note that this code is not limited to testing for a specific condition but can be used for various genetic analyses related to the HBB gene.

6. Documentation requirements

To support a claim for CPT 81361, documentation should include:

• Reason for ordering the genetic analysis procedure
• Specific variants being tested for, such as HbS, HbC, or HbE
• Date and time of the procedure
• Details of the technical steps performed by the lab analyst
• Results of the analysis, including any identified variants
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81361, ensure that the procedure is performed by a qualified lab analyst and that the analysis focuses on detecting common variants of the HBB gene. It is important to distinguish this code from other codes in the HBB genetic analysis family, such as 81362 for known familial variants, 81363 for duplication deletion analysis, and 81364 for full gene sequence analysis. Additionally, consider reporting separate codes for specimen collection or any prep work that precedes the analysis.

8. Historical information

CPT 81361 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing genetic analysis to detect HbS variants in a patient suspected of having sickle cell disease.
2. An analysis to confirm the presence of HbC variants in a patient with suspected beta thalassemia.
3. Genetic analysis to identify HbE variants in a patient being evaluated for hemoglobinopathy.
4. An analysis to determine the presence of common variants, such as HbS, HbC, or HbE, in a patient undergoing genetic carrier status evaluation.
5. Genetic analysis to detect HbS variants in a newborn as part of a newborn screening program.
6. An analysis to identify HbC variants in a patient with a family history of hemoglobinopathies.
7. Genetic analysis to confirm the presence of HbE variants in a patient with symptoms suggestive of a hemoglobinopathy.
8. An analysis to detect common variants, such as HbS, HbC, or HbE, in a patient undergoing premarital genetic testing.
9. Genetic analysis to identify HbS variants in a patient with a positive family history of sickle cell disease.
10. An analysis to determine the presence of HbC variants in a patient with unexplained anemia.