How To Use CPT Code 81427

CPT 81427 describes the re-evaluation of a previously obtained genome sequence for a patient with an unexplained constitutional or heritable disorder or syndrome. 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 81427?

CPT 81427 can be used to describe the re-evaluation of a previously obtained genome sequence for a patient with an unexplained constitutional or heritable disorder or syndrome. This code is used when a lab analyst evaluates the existing patient’s whole genome sequence analysis with reference genomic sequences at a later time, taking into account new information that was not available during the initial evaluation.

2. Official Description

The official description of CPT code 81427 is: ‘Genome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome).’

3. Procedure

1. The lab analyst reevaluates the existing patient’s whole genome sequence analysis in light of new information that was not available at the time of the initial evaluation.
2. The lab analyst may compare the existing patient’s genome sequence analysis with an existing reference genome or with a new reference whole genome sequence analysis.
3. Each additional comparator genome sequencing procedure should be reported with CPT code 81426, Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome, e.g., parents, siblings, listed separately in addition to code for primary procedure.

4. Qualifying circumstances

CPT 81427 is used for patients with an unexplained constitutional or heritable disorder or syndrome. It is typically ordered when there is a need to re-evaluate the patient’s existing whole genome sequence analysis due to new clinical information or evidence of an unrelated condition. This code is specific to the re-evaluation of previously obtained genome sequences and should not be reported for incidental findings.

5. When to use CPT code 81427

CPT code 81427 should be used when there is a need to re-evaluate a previously obtained genome sequence for a patient with an unexplained constitutional or heritable disorder or syndrome. It is important to ensure that the re-evaluation is based on new information that was not available during the initial evaluation.

6. Documentation requirements

To support a claim for CPT 81427, the lab analyst must document the following information:

• Explanation of the need for re-evaluation of the patient’s existing genome sequence analysis
• Description of the new information or evidence that prompted the re-evaluation
• Date of the re-evaluation
• Comparison of the existing patient’s genome sequence analysis with reference genomic sequences
• Signature of the lab analyst performing the re-evaluation

7. Billing guidelines

When billing for CPT 81427, ensure that the re-evaluation is performed by a qualified lab analyst. It is important to report each additional comparator genome sequencing procedure with CPT code 81426, listed separately in addition to the primary procedure code. It is also important to distinguish between the code family for exome analysis (CPT codes 81415-81417) and the code family for whole genome analysis (CPT codes 81425-81427).

8. Historical information

CPT 81427 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 reevaluating a previously obtained genome sequence for a patient with an unexplained constitutional disorder based on new clinical information.
2. A lab analyst comparing the existing patient’s genome sequence analysis with a new reference whole genome sequence analysis to identify any updated knowledge or evidence of an unrelated condition.
3. A lab analyst reevaluating a previously obtained genome sequence for a patient with a heritable syndrome in light of new information that was not available during the initial evaluation.
4. A lab analyst comparing the existing patient’s genome sequence analysis with reference genomic sequences of parents and siblings to gain further insights into an unexplained constitutional disorder.
5. A lab analyst reevaluating a previously obtained genome sequence for a patient with an unexplained heritable disorder, taking into account new evidence of an unrelated condition.
6. A lab analyst comparing the existing patient’s genome sequence analysis with a new reference whole genome sequence analysis to identify any updated knowledge or evidence of an unrelated syndrome.
7. A lab analyst reevaluating a previously obtained genome sequence for a patient with an unexplained constitutional disorder, considering new clinical information that was not available during the initial evaluation.
8. A lab analyst comparing the existing patient’s genome sequence analysis with reference genomic sequences of parents and siblings to gain further insights into an unexplained heritable disorder.
9. A lab analyst reevaluating a previously obtained genome sequence for a patient with a heritable syndrome, taking into account new evidence of an unrelated condition.
10. A lab analyst comparing the existing patient’s genome sequence analysis with a new reference whole genome sequence analysis to identify any updated knowledge or evidence of an unrelated constitutional disorder.