How To Use CPT Code 81426

CPT 81426 describes the procedure for genomic sequencing analysis, specifically the comparison of a patient’s genome to a reference genome from a relative. 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 81426?

CPT 81426 can be used to describe the procedure of genomic sequencing analysis, where a lab analyst compares a patient’s genome to a reference genome from a relative. This code is used when the lab analyst performs a full genomic sequence analysis on a relative of the patient to create a reference genome gene sequence, which is then compared to the patient’s genome to evaluate an unexplained disorder or syndrome.

2. Official Description

The official description of CPT code 81426 is: ‘Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (List separately in addition to code for primary procedure).’ This code is an add-on code and should be reported in conjunction with the primary procedure code, CPT 81425.

3. Procedure

1. The lab analyst collects a specimen, such as blood, from a relative of the patient, such as a sibling or parent.
2. The lab analyst performs full genomic sequence analysis on the collected specimen using specialized equipment, such as a next-generation gene sequencer.
3. The gene sequencer reports the comparator genome gene sequence as a string of letters, called a read.
4. The lab analyst compares the comparator genome gene sequence to the patient’s genome to evaluate an unexplained disorder or syndrome.

4. Qualifying circumstances

CPT 81426 is used when there is a need to compare a patient’s genome to a reference genome from a relative to evaluate an unexplained constitutional or heritable disorder or syndrome. This procedure is typically ordered when there are unexplained symptoms in the patient that may be associated with a genetic disorder or syndrome, especially if some family members also exhibit similar symptoms without a clear diagnosis.

5. When to use CPT code 81426

CPT code 81426 should be used when a lab analyst performs genomic sequencing analysis to compare a patient’s genome to a reference genome from a relative. This code is an add-on code and should be reported in addition to the primary procedure code, CPT 81425.

6. Documentation requirements

To support a claim for CPT 81426, the lab analyst must document the following information:

• Details of the specimen collected from the relative
• Specific equipment and techniques used for the genomic sequencing analysis
• The comparator genome gene sequence as reported by the gene sequencer
• The comparison of the comparator genome gene sequence to the patient’s genome
• Any findings or conclusions regarding the evaluation of the unexplained disorder or syndrome

7. Billing guidelines

When billing for CPT 81426, ensure that the procedure is performed by a lab analyst and that it is an add-on code reported in conjunction with the primary procedure code, CPT 81425. It is important to distinguish between the codes for exome analysis (CPT 81415-81417) and whole genome analysis (CPT 81425-81427). Some payers may reimburse separately for the collection of the specimen using a code such as CPT 36415.

8. Historical information

CPT 81426 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 genomic sequencing analysis on a sibling’s genome to compare it to the patient’s genome and evaluate an unexplained constitutional disorder.
2. Using a blood sample from a parent, a lab analyst performs genomic sequencing analysis to create a reference genome gene sequence for comparison with the patient’s genome to assess an unexplained heritable disorder.
3. Comparing the genome of a patient with unexplained symptoms to the genome of a sibling, a lab analyst performs genomic sequencing analysis to identify any genetic variants associated with a constitutional disorder.
4. Performing genomic sequencing analysis on a relative’s genome, a lab analyst compares it to the patient’s genome to evaluate an unexplained syndrome that runs in the family.
5. Using specialized equipment, a lab analyst performs genomic sequencing analysis on a parent’s genome to create a reference genome gene sequence for comparison with the patient’s genome, aiming to identify any genetic mutations associated with an unexplained disorder.
6. Comparing the genome of a patient with an unexplained constitutional disorder to the genome of a sibling, a lab analyst performs genomic sequencing analysis to identify any genetic variants that may be contributing to the patient’s condition.
7. A lab analyst performs genomic sequencing analysis on a relative’s genome to create a reference genome gene sequence, which is then compared to the patient’s genome to evaluate an unexplained heritable disorder.
8. Using a blood sample from a sibling, a lab analyst performs genomic sequencing analysis to identify any genetic variants that may be responsible for the patient’s unexplained constitutional disorder.
9. Comparing the genome of a patient with an unexplained syndrome to the genome of a parent, a lab analyst performs genomic sequencing analysis to determine if there are any genetic mutations associated with the patient’s condition.