How To Use CPT Code 81507

CPT 81507 describes the DNA sequence analysis of selected regions in maternal plasma to detect fetal aneuploidy, specifically trisomy 21, 18, and 13. 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 81507?

CPT 81507 is used to describe the DNA sequence analysis of selected regions in maternal plasma to detect fetal aneuploidy, specifically trisomy 21, 18, and 13. This test involves analyzing the patient’s blood sample using a micro assay technique and an algorithmic analysis to report a risk score for each trisomy.

2. Official Description

The official description of CPT code 81507 is: ‘Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy.’

3. Procedure

1. The lab analyst performs a micro assay technique to analyze the patient’s blood sample.
2. An algorithmic analysis is carried out using patient data and the lab test results.
3. A risk score is reported for each trisomy (21, 18, and 13) based on the algorithmic analysis.

4. Qualifying circumstances

CPT 81507 is used for patients who are undergoing prenatal screening for fetal chromosomal abnormalities, specifically trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome). This test is typically ordered for pregnant women who are at an increased risk of having a baby with one of these conditions.

5. When to use CPT code 81507

CPT code 81507 should be used when performing DNA sequence analysis of selected regions in maternal plasma to detect fetal aneuploidy, specifically trisomy 21, 18, and 13. It is important to note that this code should not be reported when performing other genomic sequencing procedures or molecular multianalyte assays for copy number analysis.

6. Documentation requirements

To support a claim for CPT 81507, the following documentation is required:

• Patient’s medical record, including relevant prenatal history
• Results of the DNA sequence analysis
• Algorithm used for the analysis
• Risk score reported for each trisomy (21, 18, and 13)
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81507, ensure that the test is performed using maternal plasma and that the algorithm is used to report a risk score for each trisomy. It is important to note that other codes, such as 81228, 81229, and 88271, should not be reported when performing genomic sequencing procedures or other molecular multianalyte assays for copy number analysis. Additionally, if there is no specific Category I or administrative code for a given multianalyte assay with algorithmic analysis, the unlisted MAAA code 81599 should be used.

8. Historical information

CPT 81507 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A pregnant woman undergoes DNA sequence analysis of selected regions in maternal plasma to detect trisomy 21, 18, and 13. The algorithmic analysis reports a risk score for each trisomy.
2. A healthcare provider orders CPT 81507 for a pregnant patient who is at an increased risk of having a baby with Down syndrome. The DNA sequence analysis is performed, and a risk score for trisomy 21 is reported.
3. A lab analyst analyzes the maternal plasma sample using a micro assay technique and reports risk scores for trisomy 21, 18, and 13 based on the algorithmic analysis.
4. A pregnant woman undergoes prenatal screening for fetal aneuploidy using CPT 81507. The DNA sequence analysis detects trisomy 18, and a risk score is reported.
5. A healthcare provider orders CPT 81507 for a pregnant patient who is at an increased risk of having a baby with Patau syndrome. The DNA sequence analysis is performed, and a risk score for trisomy 13 is reported.
6. A lab analyst performs the DNA sequence analysis of selected regions in maternal plasma to detect trisomy 21, 18, and 13. The algorithmic analysis reports risk scores for each trisomy.
7. A pregnant woman undergoes prenatal screening for fetal chromosomal abnormalities using CPT 81507. The DNA sequence analysis detects trisomy 21, and a risk score is reported.