How To Use CPT Code 81362

CPT 81362 describes the genetic analysis procedure for detecting specific changes in the hemoglobin, subunit beta (HBB) gene that are known to occur in the patient’s family. 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 81362?

CPT 81362 can be used to describe the genetic analysis procedure performed by a lab analyst to detect specific changes in the HBB gene that are known to occur in the patient’s family. This code is used when testing for genetic variants that can result in conditions such as sickle cell anemia, beta thalassemia, or other hemoglobinopathies.

2. Official Description

The official description of CPT code 81362 is: ‘HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s).’ This code represents testing for known familial variants in the HBB genes.

3. Procedure

1. The lab analyst performs the technical lab test to detect the presence of specific changes in the HBB gene that are known to occur in the patient’s family.
2. The lab analyst extracts nucleic acids from the specimen, such as blood, using methods like digestion and cell lysis.
3. The lab analyst amplifies the nucleic acids to increase and stabilize the quantity of the gene for analysis.
4. The lab analyst detects the target genes using methods such as nucleic acid probes.
5. The lab analyst performs the entire procedure, from specimen collection to gene detection, using a single unit of CPT 81362.

4. Qualifying circumstances

CPT 81362 is used when testing for known familial variants in the HBB genes. This test is commonly ordered for genetic counseling or to evaluate symptomatic patients who have a relative with a known mutation in HBB that can result in conditions such as sickle cell anemia, beta thalassemia, or other hemoglobinopathies.

5. When to use CPT code 81362

CPT code 81362 should be used when performing a genetic analysis procedure to detect known familial variants in the HBB genes. It is appropriate to bill this code when testing for specific changes in the HBB gene that are known to occur in the patient’s family. This code should not be used for testing for common variants or for full gene sequence analysis.

6. Documentation requirements

To support a claim for CPT 81362, the documentation should include:

• Reason for ordering the test, such as genetic counseling or evaluation of symptomatic patients
• Specific changes in the HBB gene that are known to occur in the patient’s family
• Date and time of the test
• Details of the technical steps performed, including nucleic acid extraction, amplification, and gene detection
• Signature of the lab analyst performing the procedure

7. Billing guidelines

When billing for CPT 81362, ensure that the procedure is performed to detect known familial variants in the HBB genes. This code should not be reported for testing for common variants or full gene sequence analysis. It is important to distinguish between the different codes in the HBB genetic analysis family, such as CPT 81361 for common variants, CPT 81362 for known familial variants, CPT 81363 for duplication deletion analysis, and CPT 81364 for full gene sequence analysis. Additionally, consider reporting separate codes for specimen collection or prep work, if applicable.

8. Historical information

CPT 81362 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 a genetic analysis procedure to detect known familial variants in the HBB genes for a patient with a family history of sickle cell anemia.
2. A genetic counselor ordering a test for known familial variants in the HBB genes to evaluate a symptomatic patient with a relative diagnosed with beta thalassemia.
3. A lab technician performing a genetic analysis procedure to detect known familial variants in the HBB genes for a patient with a family history of hemoglobinopathies.
4. A physician ordering a test for known familial variants in the HBB genes to provide genetic counseling for a couple planning to have children.
5. A hematologist ordering a test for known familial variants in the HBB genes to confirm a diagnosis of sickle cell anemia in a patient with symptoms.
6. A lab analyst performing a genetic analysis procedure to detect known familial variants in the HBB genes for a patient with a family history of beta thalassemia.
7. A genetic counselor ordering a test for known familial variants in the HBB genes to evaluate a symptomatic patient with a relative diagnosed with sickle cell anemia.
8. A lab technician performing a genetic analysis procedure to detect known familial variants in the HBB genes for a patient with a family history of hemoglobinopathies.
9. A physician ordering a test for known familial variants in the HBB genes to provide genetic counseling for a couple planning to have children.
10. A hematologist ordering a test for known familial variants in the HBB genes to confirm a diagnosis of beta thalassemia in a patient with symptoms.