How To Use CPT Code 81411

CPT 81411 describes the analysis panel for aortic dysfunction or dilation, specifically evaluating genetic duplications and deletions of at least four genes related to these conditions. 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 81411?

CPT 81411 can be used to analyze genetic duplications and deletions of at least four specific genes associated with aortic dysfunction or dilation. This code is used to evaluate patients who may have conditions such as Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, or arterial tortuosity syndrome. The analysis panel helps identify mutations that may not be detected by other gene sequencing tests, providing valuable information for diagnosis and treatment.

2. Official Description

The official description of CPT code 81411 is: ‘Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1.’

3. Procedure

1. The lab analyst performs a duplication and deletion analysis panel on a patient specimen, typically blood.
2. The analysis focuses on at least four specific genes: TGFBR1, TGFBR2, MYH11, and COL3A1.
3. The lab analyst may use methods like Multiplex Ligation dependent Probe Amplification (MLPA) to detect large deletions and duplications of nucleotide sequences that standard DNA sequencing methods may not identify.
4. The analysis aims to identify genetic mutations associated with aortic dysfunction or dilation, which may be indicative of conditions like Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, or arterial tortuosity syndrome.

4. Qualifying circumstances

CPT 81411 is used for patients suspected of having aortic dysfunction or dilation conditions such as Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, or arterial tortuosity syndrome. The analysis panel focuses on specific genes (TGFBR1, TGFBR2, MYH11, and COL3A1) associated with these conditions. Clinicians may order this test as a follow-up to gene sequencing tests (CPT 81410) for patients with negative results, as some mutations may not be detected by the initial test.

5. When to use CPT code 81411

CPT code 81411 should be used when evaluating patients suspected of having aortic dysfunction or dilation conditions, specifically Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, or arterial tortuosity syndrome. It is typically ordered as a follow-up test when gene sequencing tests (CPT 81410) yield negative results but there is still suspicion of a genetic mutation related to these conditions.

6. Documentation requirements

To support a claim for CPT 81411, the documentation should include:

• Patient’s clinical history and symptoms indicating the need for the analysis
• Specific genes analyzed (TGFBR1, TGFBR2, MYH11, and COL3A1)
• Method used for the analysis, such as Multiplex Ligation dependent Probe Amplification (MLPA)
• Date and time of the analysis
• Results of the analysis, including any identified duplications or deletions
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81411, ensure that the analysis panel includes the required genes (TGFBR1, TGFBR2, MYH11, and COL3A1). It is important to distinguish between CPT 81410 and CPT 81411, as they represent different tests. If both analyses are performed, report both codes. Additionally, consider using a separate code for specimen collection, such as CPT 36415. Review payer guidelines for specific billing requirements and modifiers, if applicable.

8. Historical information

CPT 81411 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 81411

Five similar codes to CPT 81411 include:

• CPT 81410: Aortic dysfunction or dilation analysis panel, genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK.
• CPT 81412: Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for FBN1, TGFBR1, TGFBR2, MYH11, COL3A1, ACTA2, SLC2A10, SMAD3, and MYLK.
• CPT 81415: Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for FBN1, TGFBR1, TGFBR2, MYH11, COL3A1, ACTA2, SLC2A10, SMAD3, MYLK, and NOTCH1.
• CPT 81420: Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for FBN1, TGFBR1, TGFBR2, MYH11, COL3A1, ACTA2, SLC2A10, SMAD3, MYLK, NOTCH1, and TGFB2.