How To Use CPT Code 81376

CPT 81376 describes the low or intermediate resolution typing of HLA Class II genes, which are responsible for coding proteins on the surface of cells. 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 81376?

CPT 81376 is used to identify specific alleles for one HLA Class II locus, such as HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1. This code is used for low or intermediate resolution typing, which means identifying the alleles without high specificity, such as to the level of the two-digit HLA name or as a string of alleles or a National Bone Marrow Donor Program code.

2. Official Description

The official description of CPT code 81376 is: ‘HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each.’ Notes: When low resolution typing is performed for HLA-DRB1/3/4/5 and-DQB1, use 81375. When HLA typing includes a determination of the presence or absence of the DRB3/4/5 genes, that service is included in the typing and is not separately reported. When low or intermediate resolution typing of any or all of the DRB3/4/5 genes is performed, treat as one locus.

3. Procedure

1. The lab analyst performs the technical lab test for low or intermediate resolution assessment of human leukocyte antigen genes, called HLA, for one Class II locus using molecular techniques.
2. The lab analyst extracts the nucleic acids by methods such as cell lysis and digestion, and identifies the target HLA gene sequences by methods such as amplification and hybridization with nucleic acid probes or direct sequencing-based typing.

4. Qualifying circumstances

CPT 81376 is ordered by clinicians to assess donor/recipient compatibility for solid organ or hematopoietic stem cell transplants. It can also be ordered to identify an HLA Class II allele that indicates specific disease states. There are no specific qualifying circumstances mentioned for this code.

5. When to use CPT code 81376

CPT code 81376 should be used when low or intermediate resolution HLA typing is performed for one Class II locus, such as HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1. It is important to note that if the test involves all Class II loci HLA-DRB1/3/4/5 and -DQB1, CPT code 81375 should be used instead.

6. Documentation requirements

To support a claim for CPT 81376, the documentation should include:

• Reason for ordering the test
• Specific alleles identified for the HLA Class II locus
• Details of the technical steps performed by the lab analyst
• Interpretation and report by an MD or DO physician, if separately requested

7. Billing guidelines

When billing for CPT 81376, ensure that the test involves low or intermediate resolution typing for one HLA Class II locus. If the test involves more than one Class II locus, report one unit of CPT 81376 for each locus. It is important to use the fewest number of codes possible to account for the testing. If the lab analyst performs HLA Class II typing by serology, different codes should be used instead of CPT 81376. If the ordering clinician separately requests physician interpretation of the test, an additional code may be reported with modifier 26. Always follow the specific guidelines provided by the payer.

8. Historical information

CPT 81376 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 lab analyst performs low resolution typing of HLA-DRB1 for a patient undergoing a solid organ transplant.
2. A clinician orders low resolution typing of HLA-DQB1 to identify an HLA Class II allele associated with a specific disease state.
3. A lab analyst performs intermediate resolution typing of HLA-DRB3/4/5 for a patient being evaluated for hematopoietic stem cell transplantation.
4. A clinician requests low resolution typing of HLA-DPA1 to assess donor/recipient compatibility for a solid organ transplant.
5. A lab analyst performs low resolution typing of HLA-DPB1 to determine the HLA Class II allele for a patient with an autoimmune disorder.
6. A clinician orders low resolution typing of HLA-DQA1 to identify an HLA Class II allele associated with a specific disease state.
7. A lab analyst performs intermediate resolution typing of HLA-DRB1 for a patient being evaluated for hematopoietic stem cell transplantation.
8. A clinician requests low resolution typing of HLA-DRB3/4/5 to assess donor/recipient compatibility for a solid organ transplant.
9. A lab analyst performs low resolution typing of HLA-DQB1 to determine the HLA Class II allele for a patient with an autoimmune disorder.