How To Use CPT Code 81436

CPT 81436 describes the analysis panel for hereditary colon cancer disorders, specifically evaluating duplication and deletion mutations in at least five genes. 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 81436?

CPT 81436 can be used to describe the analysis panel for hereditary colon cancer disorders. It specifically evaluates duplication and deletion mutations in at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11. This code is used when the lab analyst performs a panel to assess the patient specimen for these specific mutations related to hereditary colon cancer syndromes.

2. Official Description

The official description of CPT code 81436 is: ‘Hereditary colon cancer disorders (e.g., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11.’

3. Procedure

1. The lab analyst performs duplication and deletion analysis for at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11.
2. The analysis is conducted using a patient specimen, such as blood, to evaluate the presence of duplication and deletion mutations in these genes.
3. The lab analyst may use methods like multiplex-ligation-dependent probe amplification (MLPA) to detect duplications and deletions in nucleotide sequences that normal DNA sequencing methods may not detect.
4. This analysis panel is commonly ordered for patients with suspected hereditary colon cancer syndromes who have tested negative for mutations using full gene sequencing.
5. It is important to distinguish between CPT 81436 and CPT 81435, as the former focuses on duplication and deletion analysis, while the latter involves genomic sequence analysis of at least 10 genes.

4. Qualifying circumstances

Patients who may require CPT 81436 analysis are those with suspected hereditary colon cancer syndromes who have tested negative for mutations using full gene sequencing. The analysis specifically evaluates duplication and deletion mutations in at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11. The presence of these mutations may indicate the presence of hereditary colon cancer disorders such as Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, or familial adenomatosis polyposis.

5. When to use CPT code 81436

CPT code 81436 should be used when there is a need to evaluate duplication and deletion mutations in at least five specific genes related to hereditary colon cancer disorders. It is appropriate to use this code when the lab analyst performs the analysis panel using a patient specimen, such as blood, and the genes analyzed include MLH1, MSH2, EPCAM, SMAD4, and STK11.

6. Documentation requirements

To support a claim for CPT 81436, the documentation should include:

• Indication of the suspected hereditary colon cancer syndrome
• Specific genes analyzed, including MLH1, MSH2, EPCAM, SMAD4, and STK11
• Method used for duplication and deletion analysis, such as MLPA
• Date of the analysis
• Results of the analysis, indicating the presence or absence of duplication and deletion mutations
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81436, ensure that the analysis panel includes evaluation of duplication and deletion mutations in at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11. It is important to distinguish between CPT 81436 and CPT 81435, as they involve different types of analysis. Additionally, consider reporting other molecular pathology codes for tests involving the same genes included in CPT 81436, but avoid reporting additional codes for the same analysis panel.

8. Historical information

CPT 81436 was added to the Current Procedural Terminology system on January 1, 2015. On January 1, 2016, there was a code change that expanded the number of genes included in the analysis panel for hereditary colon cancer disorders.

9. Examples

1. A lab analyst performs duplication and deletion analysis for MLH1, MSH2, EPCAM, SMAD4, and STK11 genes in a patient specimen to evaluate the presence of hereditary colon cancer disorders.
2. Using multiplex-ligation-dependent probe amplification (MLPA), the lab analyst detects duplications and deletions in the MLH1, MSH2, EPCAM, SMAD4, and STK11 genes of a patient with suspected Lynch syndrome.
3. The analysis panel for hereditary colon cancer disorders includes evaluation of duplication and deletion mutations in MLH1, MSH2, EPCAM, SMAD4, and STK11 genes for a patient who tested negative for mutations using full gene sequencing.
4. A lab analyst performs duplication and deletion analysis for MLH1, MSH2, EPCAM, SMAD4, and STK11 genes in a patient specimen to assess the presence of hereditary colon cancer syndromes, such as Cowden syndrome or familial adenomatosis polyposis.
5. Using a patient specimen, the lab analyst evaluates duplication and deletion mutations in MLH1, MSH2, EPCAM, SMAD4, and STK11 genes to determine the risk of hereditary colon cancer disorders in a patient with a family history of the disease.