How To Use CPT Code 81420

CPT 81420 involves a genomic sequence analysis panel for fetal chromosomal aneuploidy, focusing on chromosomes 13, 18, and 21. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 81420.

1. What is CPT 81420?

CPT 81420 is a medical procedure code used to describe a genomic sequence analysis panel performed on circulating cell-free fetal DNA (cffDNA) in maternal blood. This test is primarily used to detect fetal chromosomal aneuploidies, such as trisomy 21 (Down Syndrome), monosomy X, and other abnormalities related to chromosomes 13, 18, and 21.

2. 81420 CPT code description

The official description of CPT code 81420 is: “Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21.”

3. Procedure

1. Collect maternal blood sample.
2. Isolate cffDNA from the blood sample using methods such as centrifugation or column separation.
3. Perform genomic sequence analysis on the isolated cffDNA using specialized equipment like a next-generation gene sequencer.
4. Compare the obtained gene sequences (reads) to a reference genome to identify any abnormalities in chromosomes 13, 18, and 21.
5. Report the findings to the ordering clinician for further evaluation and diagnosis.

4. Qualifying circumstances

Patients eligible to receive CPT code 81420 services are pregnant women whose fetuses are at risk for chromosomal aneuploidies. This may include women with advanced maternal age, abnormal ultrasound findings, or a family history of chromosomal abnormalities. The test can also be used for women with a positive result from a previous screening test, such as a first-trimester combined test or a second-trimester quadruple test.

5. When to use CPT code 81420

It is appropriate to bill the 81420 CPT code when a clinician orders a genomic sequence analysis panel for fetal chromosomal aneuploidy using cffDNA in maternal blood. The test should focus on the analysis of chromosomes 13, 18, and 21, as these are the most common chromosomes associated with fetal aneuploidies in live births.

6. Documentation requirements

To support a claim for CPT 81420, the following information should be documented:

• Patient’s demographic information, including age and gestational age.
• Indication for the test, such as advanced maternal age, abnormal ultrasound findings, or family history of chromosomal abnormalities.
• Details of the blood sample collection, including date and time.
• Methods used for isolating cffDNA and performing genomic sequence analysis.
• Results of the analysis, including any identified abnormalities in chromosomes 13, 18, and 21.
• Interpretation of the results and any recommendations for further testing or follow-up.

7. Billing guidelines

When billing for CPT code 81420, it is important to follow the specific guidelines and rules set by the payer. Some payers may pay separately for the collection of the blood sample using a code such as 36415. Additionally, do not report codes 81228, 81229, 88271, or 81349 when performing genomic sequencing procedures or other molecular multianalyte assays for copy number analysis, as these codes are not applicable to CPT 81420.

8. Historical information

CPT 81420 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 81420

Five similar codes to CPT 81420 and how they differ are:

• CPT 81422: Focuses on the analysis of additional chromosomes beyond 13, 18, and 21.
• CPT 81425: Involves a more comprehensive genomic sequence analysis panel for fetal chromosomal abnormalities.
• CPT 81426: Targets specific chromosomal regions or genes for analysis, rather than a full panel.
• CPT 81427: Analyzes a single gene for a known familial chromosomal abnormality.
• CPT 81430: Evaluates the entire fetal genome for chromosomal abnormalities, rather than specific chromosomes.

10. Examples

Here are 10 detailed examples of CPT code 81420 procedures:

1. A 35-year-old pregnant woman with a family history of Down Syndrome undergoes CPT 81420 testing to assess her fetus’s risk for chromosomal abnormalities.
2. A pregnant woman with an abnormal ultrasound finding suggestive of trisomy 18 has CPT 81420 testing performed to confirm the diagnosis.
3. A 40-year-old pregnant woman undergoes CPT 81420 testing as part of her prenatal care due to her advanced maternal age.
4. A pregnant woman with a positive result from a first-trimester combined test has CPT 81420 testing performed to further evaluate her fetus’s risk for chromosomal abnormalities.
5. A pregnant woman with a previous child diagnosed with trisomy 13 undergoes CPT 81420 testing to assess her current fetus’s risk for the same condition.
6. A pregnant woman with a positive result from a second-trimester quadruple test has CPT 81420 testing performed to further evaluate her fetus’s risk for chromosomal abnormalities.
7. A pregnant woman with a history of recurrent miscarriages undergoes CPT 81420 testing to assess her fetus’s risk for chromosomal abnormalities.
8. A pregnant woman with a known chromosomal abnormality in her family undergoes CPT 81420 testing to assess her fetus’s risk for the same condition.
9. A pregnant woman with a previous child diagnosed with monosomy X undergoes CPT 81420 testing to assess her current fetus’s risk for the same condition.
10. A pregnant woman with a history of unexplained stillbirth undergoes CPT 81420 testing to assess her fetus’s risk for chromosomal abnormalities.