How To Use CPT Code 81415

CPT 81415 describes the procedure for exome gene sequence analysis, which is used to identify genetic changes that may be responsible for unexplained disorders or syndromes. This article will provide an overview of CPT 81415, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 81415?

CPT 81415 is a code that represents the procedure for exome gene sequence analysis. This test is performed to examine the genetic material of a patient, specifically the exome, which is the portion of the genome that contains the DNA sequences that code for proteins. By analyzing the exome, healthcare professionals can identify genetic changes that may be responsible for unexplained disorders or syndromes in the patient.

2. Official Description

The official description of CPT code 81415 is: ‘Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis.’

3. Procedure

1. The procedure begins with the collection of a patient specimen, typically blood, which will be used for the exome gene sequence analysis.
2. The lab analyst performs the analysis using specialized equipment, such as a next-generation gene sequencer, to determine the order of nucleotides in the patient’s DNA.
3. The gene sequencer generates a read, which is a string of letters representing the patient’s exome gene sequence.
4. The lab analyst compares the patient’s exome gene sequence to a reference exome to identify any genetic changes or variants.
5. The results of the analysis are used to aid in the diagnosis of unexplained disorders or syndromes in the patient.

4. Qualifying circumstances

CPT 81415 is used when there is a need to investigate unexplained constitutional or heritable disorders or syndromes in a patient. This test is typically ordered when there are symptoms present that cannot be explained by other means, and there is a suspicion of a genetic cause. It is important to note that this test examines only the exome, which represents a small subset of the entire genome.

5. When to use CPT code 81415

CPT code 81415 should be used when there is a clinical suspicion of a genetic cause for an unexplained disorder or syndrome. It is appropriate to bill this code when performing exome gene sequence analysis to identify genetic changes that may be responsible for the patient’s condition.

6. Documentation requirements

To support a claim for CPT 81415, the healthcare professional must document the following information:

• Reason for ordering the test, including the presence of unexplained symptoms or suspicion of a genetic cause
• Details of the procedure performed, including the collection of the patient specimen and the use of specialized equipment
• Results of the exome gene sequence analysis, including any identified genetic changes or variants
• Signature of the healthcare professional ordering or performing the test

7. Billing guidelines

When billing for CPT 81415, ensure that the procedure performed is exome gene sequence analysis for an unexplained constitutional or heritable disorder or syndrome. It is important to distinguish this code from other codes that represent different types of genetic testing. Additionally, be aware of any specific billing guidelines or requirements set by payers.

8. Historical information

CPT 81415 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. Examples

1. A patient presents with unexplained developmental delays and intellectual disabilities. CPT code 81415 is used to perform exome gene sequence analysis to identify any genetic changes that may be responsible for the patient’s condition.
2. A family has a history of unexplained cardiac abnormalities. CPT code 81415 is used to investigate the presence of genetic changes that may be associated with the family’s cardiac conditions.
3. A newborn exhibits symptoms of a rare metabolic disorder. CPT code 81415 is used to perform exome gene sequence analysis to identify any genetic changes that may be responsible for the newborn’s condition.
4. A patient presents with unexplained muscle weakness and fatigue. CPT code 81415 is used to investigate the presence of genetic changes that may be associated with the patient’s symptoms.
5. A family has a history of unexplained neurological disorders. CPT code 81415 is used to perform exome gene sequence analysis to identify any genetic changes that may be responsible for the family’s neurological conditions.
6. A patient presents with unexplained vision loss. CPT code 81415 is used to investigate the presence of genetic changes that may be associated with the patient’s symptoms.
7. A family has a history of unexplained immune system abnormalities. CPT code 81415 is used to perform exome gene sequence analysis to identify any genetic changes that may be responsible for the family’s immune system conditions.
8. A patient presents with unexplained gastrointestinal symptoms. CPT code 81415 is used to investigate the presence of genetic changes that may be associated with the patient’s symptoms.