How To Use CPT Code 88291

CPT 88291 describes the interpretation and report of cytogenetic and molecular cytogenetic testing by a qualified provider, typically a pathologist. 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 88291?

CPT 88291 can be used to describe the interpretation and report of cytogenetic and molecular cytogenetic testing. This code is used when a qualified provider, usually a pathologist, reviews the results of these procedures, such as chromosome analysis, karyotyping, and in situ hybridization testing. The provider interprets the assay results, taking into account additional patient medical information, and provides a report of their analysis and recommendations.

2. Official Description

The official description of CPT code 88291 is: ‘Cytogenetics and molecular cytogenetics, interpretation and report.’

3. Procedure

1. A qualified provider, typically a pathologist, reviews the results of cytogenetic and molecular cytogenetic procedures, such as chromosome analysis, karyotyping, and in situ hybridization testing.
2. The provider interprets the assay results, typically with additional patient medical information.
3. The provider provides a report of their analysis and recommendations based on the interpretation of the results.

4. Qualifying circumstances

CPT 88291 is used when a qualified provider, usually a pathologist, interprets and reports cytogenetic and molecular cytogenetic testing. This code is typically used for patients who have undergone these tests to identify inherited or acquired chromosomal abnormalities. The provider must have the necessary qualifications to perform the interpretation and report.

5. When to use CPT code 88291

CPT code 88291 should be used when a qualified provider, typically a pathologist, interprets and reports cytogenetic and molecular cytogenetic testing. This code is appropriate when the provider reviews the results of these procedures and provides a detailed analysis and recommendations based on their interpretation. It should not be used if the interpretation and report are performed solely by a licensed PhD, even if allowed by local state law.

6. Documentation requirements

To support a claim for CPT 88291, the provider must document the following information:

• Results of the cytogenetic and molecular cytogenetic testing
• Additional patient medical information used in the interpretation
• Detailed analysis and recommendations based on the interpretation
• Signature of the qualified provider performing the interpretation and report

7. Billing guidelines

When billing for CPT 88291, ensure that the interpretation and report are performed by a qualified provider, typically a pathologist. Medicare only pays for this code as a physician service, and it cannot be billed by an independent lab or hospital lab if a licensed PhD alone performs the interpretation and report. Consider using modifier TC for the technical component and modifier 26 for the professional component, depending on the location and circumstances of the testing.

8. Historical information

CPT 88291 was added to the Current Procedural Terminology system on January 1, 1999. There have been no updates to the code since its addition.

9. Examples

1. A pathologist interpreting and reporting the results of chromosome analysis for a patient with suspected genetic abnormalities.
2. A qualified provider analyzing the results of in situ hybridization testing to identify specific genetic mutations in a cancer patient.
3. A pathologist reviewing the karyotype of a patient to determine if there are any chromosomal abnormalities associated with a developmental disorder.
4. A provider interpreting and reporting the results of molecular cytogenetic testing to identify genetic markers associated with a specific disease.
5. A qualified provider analyzing the results of chromosome analysis in a prenatal patient to assess the risk of genetic abnormalities in the fetus.
6. A pathologist reviewing the results of in situ hybridization testing to determine the presence of specific genetic mutations in a patient with a suspected genetic disorder.
7. A provider interpreting and reporting the results of molecular cytogenetic testing to identify chromosomal abnormalities in a patient with cancer.
8. A qualified provider analyzing the karyotype of a patient to assess the risk of genetic abnormalities in future pregnancies.
9. A pathologist reviewing the results of chromosome analysis to determine if there are any chromosomal abnormalities associated with a patient’s infertility.
10. A provider interpreting and reporting the results of molecular cytogenetic testing to identify genetic markers associated with a patient’s response to a specific medication.