How To Use CPT Code 81433

CPT 81433 describes the duplication and deletion analysis panel for hereditary breast cancer-related disorders. 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 81433?

CPT 81433 can be used to evaluate genetic duplications and deletions related to hereditary breast cancer-related disorders. This code is specifically used for a panel analysis that includes the assessment of at least five genes, including BRCA1, BRCA2, MLH1, MSH2, and STK11. The purpose of this analysis is to identify alterations in DNA that may lead to pathologic changes associated with hereditary breast cancer mutations.

2. Official Description

The official description of CPT code 81433 is: ‘Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11.’

3. Procedure

1. The lab analyst performs a duplication and deletion analysis panel using a patient specimen, such as blood.
2. The analysis includes the evaluation of at least five genes: BRCA1, BRCA2, MLH1, MSH2, and STK11.
3. The lab analyst may use methods like Multiplex Ligation dependent Probe Amplification (MLPA) to detect large deletions and duplications of nucleotide sequences that may not be detected by normal DNA sequencing methods.
4. The analysis aims to identify genetic duplications and deletions that may be associated with hereditary breast cancer-related disorders.

4. Qualifying circumstances

CPT 81433 is used for patients with known familial BRCA1 or BRCA2 large deletions or duplications. It can also be used as a follow-up test for symptomatic patients who have received negative results from a gene sequencing test. This code is specifically for the duplication and deletion analysis panel and should not be reported separately for individual gene tests.

5. When to use CPT code 81433

CPT code 81433 should be used when evaluating patients with known familial BRCA1 or BRCA2 large deletions or duplications. It can also be used as a follow-up test for symptomatic patients who have received negative results from a gene sequencing test. This code is not appropriate for routine screening or testing unrelated to hereditary breast cancer-related disorders.

6. Documentation requirements

To support a claim for CPT 81433, the documentation should include:

• Indication of the patient’s known familial BRCA1 or BRCA2 large deletions or duplications
• Details of the duplication and deletion analysis panel, including the genes analyzed (BRCA1, BRCA2, MLH1, MSH2, and STK11)
• Method used for the analysis, such as Multiplex Ligation dependent Probe Amplification (MLPA)
• Date of the analysis
• Results of the analysis, including any identified genetic duplications or deletions
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81433, ensure that the analysis includes the required genes (BRCA1, BRCA2, MLH1, MSH2, and STK11). Do not report this code separately for individual gene tests. It is important to note that some payers may provide separate reimbursement for specimen collection using a code such as 36415. Additionally, CPT provides other molecular pathology codes for tests involving some of the genes included in the 81433 panel, but these should not be reported in addition to 81433.

8. Historical information

CPT 81433 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A patient with a known familial BRCA1 large duplication receives a duplication and deletion analysis panel using CPT code 81433.
2. A symptomatic patient with negative results from a gene sequencing test for hereditary breast cancer-related disorders undergoes a follow-up duplication and deletion analysis panel using CPT code 81433.
3. A patient with a known familial BRCA2 large deletion receives a duplication and deletion analysis panel using CPT code 81433.
4. A patient with a known familial MLH1 duplication receives a duplication and deletion analysis panel using CPT code 81433.
5. A patient with a known familial MSH2 deletion receives a duplication and deletion analysis panel using CPT code 81433.