How To Use CPT Code 81425

CPT 81425 describes the procedure for genome sequence analysis, specifically for patients with unexplained constitutional or heritable disorders or syndromes. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81425?

CPT 81425 can be used to describe the procedure of genome sequence analysis for patients with unexplained constitutional or heritable disorders or syndromes. This code is used when a lab analyst performs a gene sequence analysis of the entire patient genome to identify any genetic changes that may be responsible for the patient’s unexplained condition.

2. Official Description

The official description of CPT code 81425 is: ‘Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis.’

3. Procedure

1. The lab analyst collects a patient specimen, such as blood, for analysis.
2. Using specialized equipment, such as a next-generation gene sequencer, the lab analyst performs a whole genome sequence analysis.
3. The gene sequencer determines the order of nucleotides in the patient’s DNA and reports it as a string of letters, called a read.
4. The lab analyst compares the patient genome gene sequence to a reference genome to identify any genetic changes.
5. The goal of this test is to compare the patient genome to family member genomes as the reference to identify any variants that may be associated with the patient’s unexplained condition.

4. Qualifying circumstances

CPT 81425 is used for patients with unexplained constitutional or heritable disorders or syndromes. This test is ordered when a patient presents with unexplained symptoms that may be associated with a genetic disorder or syndrome. It is particularly useful when other family members also exhibit similar symptoms without a clear diagnosis. The test is performed by a lab analyst using a patient specimen, such as blood.

5. When to use CPT code 81425

CPT code 81425 should be used when a lab analyst performs a genome sequence analysis for a patient with an unexplained constitutional or heritable disorder or syndrome. It is important to note that this code is specifically for whole genome analysis and should not be confused with codes for exome analysis.

6. Documentation requirements

To support a claim for CPT 81425, the following documentation is required:

• Reason for ordering the test, including the patient’s unexplained symptoms and any relevant family history
• Details of the specimen collected for analysis
• Date of the analysis
• Results of the genome sequence analysis, including any genetic changes or variants identified
• Comparison to reference genomes, if applicable
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81425, ensure that the procedure is performed by a lab analyst and that the patient meets the qualifying circumstances for the test. It is important to distinguish between whole genome analysis and exome analysis codes. Additionally, consider any separate codes that may be required for specimen collection.

8. Historical information

CPT 81425 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a genome sequence analysis for a patient with an unexplained developmental disorder.
2. A patient presents with a hereditary cancer syndrome, and a genome sequence analysis is performed to identify any genetic changes associated with the syndrome.
3. A family with multiple members exhibiting unexplained symptoms undergoes genome sequence analysis to identify any shared genetic variants.
4. A patient with a suspected genetic disorder undergoes a genome sequence analysis to determine the cause of their symptoms.
5. A lab analyst performs a genome sequence analysis for a patient with an unexplained intellectual disability.
6. A patient with a suspected heritable cardiac condition undergoes genome sequence analysis to identify any genetic changes associated with the condition.
7. A family with a history of neurodegenerative disorders undergoes genome sequence analysis to identify any genetic variants that may be responsible for the disorders.
8. A patient with an unexplained connective tissue disorder undergoes genome sequence analysis to identify any genetic changes associated with the disorder.
9. A child with multiple congenital anomalies undergoes genome sequence analysis to identify any genetic changes that may be responsible for the anomalies.
10. A patient with an unexplained metabolic disorder undergoes genome sequence analysis to identify any genetic changes associated with the disorder.