How To Use CPT Code 81511
CPT 81511 describes the biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) 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 81511?
CPT 81511 is used to describe the biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to assess the risk of fetal congenital abnormalities. This code is used when the lab analyst performs the technical lab tests 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 81511 is: ‘Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing).’
3. Procedure
- The lab analyst performs biochemical assays for four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum.
- The lab analyst inputs the test results and patient information, possibly including prior test results, into a computer program to analyze the data using a specific algorithm.
- The algorithmic analysis produces a risk score that is reported to assess the risk of fetal congenital abnormalities.
4. Qualifying circumstances
CPT 81511 is used when assessing the risk of fetal congenital abnormalities in pregnant patients. It involves the biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum. This code should not be reported in conjunction with codes 82105, 82677, 84702, or 86336.
5. When to use CPT code 81511
CPT code 81511 should be used when performing biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to assess the risk of fetal congenital abnormalities. It is appropriate to use this code when the lab analyst carries out an algorithmic analysis using patient data and the lab test results to report a patient risk score.
6. Documentation requirements
To support a claim for CPT 81511, the lab analyst must document the following information:
- Patient’s demographic information
- Test results for the four analytes (AFP, uE3, hCG [any form], DIA)
- Algorithmic analysis used to calculate the risk score
- Reported risk score
7. Billing guidelines
When billing for CPT 81511, ensure that the biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum are performed. Do not report this code in conjunction with codes 82105, 82677, 84702, or 86336. Medicare and some other payers may not accept CPT 81511 and may require billing only the underlying test codes.
8. Historical information
CPT 81511 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
- A pregnant patient undergoes biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to assess the risk of fetal congenital abnormalities. The lab analyst performs the assays and carries out an algorithmic analysis to report a patient risk score.
- Another pregnant patient with abnormal prior test results undergoes biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to further assess the risk of fetal congenital abnormalities. The lab analyst performs the assays and includes the additional results from previous biochemical testing in the algorithmic analysis to report a patient risk score.
- A third pregnant patient with a high-risk pregnancy undergoes biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to evaluate the risk of fetal congenital abnormalities. The lab analyst performs the assays and reports a patient risk score based on the algorithmic analysis.
- Another pregnant patient with a history of fetal congenital abnormalities undergoes biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) in maternal serum to monitor the risk of recurrence. The lab analyst performs the assays and reports a patient risk score based on the algorithmic analysis.
