How To Use CPT Code 81510

CPT 81510 describes the biochemical assays of three analytes (AFP, uE3, hCG [any form]) in maternal serum to assess the risk of fetal congenital abnormalities. 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 81510?

CPT 81510 is used to describe the biochemical assays of three analytes (AFP, uE3, hCG [any form]) in maternal serum to assess the risk of fetal congenital abnormalities. This code is used when a lab analyst performs the technical lab tests for these analytes and carries out an algorithmic analysis using patient data and the lab test results to report a patient risk score.

2. Official Description

The official description of CPT code 81510 is: ‘Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score.’

3. Procedure

1. The lab analyst performs biochemical assays for three analytes (AFP, uE3, hCG [any form]) in maternal serum.
2. The lab analyst inputs the test results and patient information, such as the date of the last menstrual period, into a computer program.
3. The computer program uses a specific algorithm to analyze the data and calculate a risk score.
4. The lab analyst reports the risk score to the healthcare provider.

4. Qualifying circumstances

CPT 81510 is used when a healthcare provider orders a maternal blood test during the second trimester to screen for fetal congenital abnormalities, such as Down syndrome (trisomy 21), trisomy 18, or open neural tube defects. The test involves the biochemical assays of three analytes (AFP, uE3, hCG [any form]) in maternal serum, and the algorithmic analysis is used to calculate a risk score.

5. When to use CPT code 81510

CPT code 81510 should be used when a healthcare provider orders a maternal blood test during the second trimester to assess the risk of fetal congenital abnormalities. It should not be reported in conjunction with CPT codes 82105, 82677, or 84702, as CPT 81510 includes the underlying lab tests. Medicare and some other payers may not accept CPT 81510 and may require billing only the underlying test codes.

6. Documentation requirements

To support a claim for CPT 81510, the healthcare provider must document the following information:

• Patient’s demographic information
• Date of the last menstrual period
• Results of the biochemical assays for AFP, uE3, and hCG
• Algorithmic analysis and the calculated risk score
• Signature of the lab analyst performing the tests

7. Billing guidelines

When billing for CPT 81510, ensure that the healthcare provider orders the maternal blood test during the second trimester and that the test involves the biochemical assays of three analytes (AFP, uE3, hCG [any form]). Do not report CPT codes 82105, 82677, or 84702 in addition to CPT 81510, as the MAAA codes always include the underlying lab tests. Use the unlisted MAAA code, 81599, only when there is no Category I or administrative code for a specific MAAA test.

8. Historical information

CPT 81510 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider orders CPT code 81510 for a pregnant patient during the second trimester to assess the risk of Down syndrome.
2. A lab analyst performs the biochemical assays for AFP, uE3, and hCG in maternal serum and calculates a risk score using an algorithmic analysis for a patient with a suspected open neural tube defect.
3. A healthcare provider orders CPT code 81510 for a pregnant patient during the second trimester to assess the risk of trisomy 18.
4. A lab analyst performs the biochemical assays for AFP, uE3, and hCG in maternal serum and calculates a risk score using an algorithmic analysis for a patient with a suspected trisomy 21.
5. A healthcare provider orders CPT code 81510 for a pregnant patient during the second trimester to assess the risk of fetal congenital abnormalities.
6. A lab analyst performs the biochemical assays for AFP, uE3, and hCG in maternal serum and calculates a risk score using an algorithmic analysis for a patient with a suspected trisomy 18.
7. A healthcare provider orders CPT code 81510 for a pregnant patient during the second trimester to assess the risk of an open neural tube defect.
8. A lab analyst performs the biochemical assays for AFP, uE3, and hCG in maternal serum and calculates a risk score using an algorithmic analysis for a patient with a suspected trisomy 21.
9. A healthcare provider orders CPT code 81510 for a pregnant patient during the second trimester to assess the risk of fetal congenital abnormalities.
10. A lab analyst performs the biochemical assays for AFP, uE3, and hCG in maternal serum and calculates a risk score using an algorithmic analysis for a patient with a suspected open neural tube defect.