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The CPT® Code 81201 pertains to the molecular genetic testing of the adenomatous polyposis coli (APC) gene, specifically focusing on the full gene sequence analysis. This testing is crucial for identifying mutations within the APC gene that are responsible for familial adenomatosis polyposis (FAP), a hereditary condition characterized by the development of numerous polyps in the colon and rectum, which can lead to colorectal cancer if left untreated. FAP is inherited in an autosomal dominant manner, meaning that an individual only needs to inherit the mutated gene from one parent to be affected by the condition. The classic form of FAP is typically more severe than its attenuated counterpart, which presents with fewer polyps and a later onset of symptoms. The APC gene plays a vital role as a tumor suppressor, and mutations in this gene disrupt its function, leading to uncontrolled cell growth and polyp formation. The gene is located on chromosome 5, and over 700 distinct mutations have been documented, often resulting in a truncated, nonfunctional APC protein. The testing process may involve comprehensive gene sequencing, which is specifically reported under code 81201, allowing for the identification of various mutations, including those that may be linked to other syndromes such as Turcot syndrome. Additionally, the APC gene has known variants, such as the I1307K mutation prevalent in the Ashkenazi Jewish population, which is associated with an increased risk of colon cancer. Understanding these genetic factors is essential for risk assessment and management in affected individuals and their families.
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The molecular genetic testing for the APC gene is indicated for individuals who are suspected of having familial adenomatosis polyposis (FAP) based on family history or clinical presentation. The following conditions may warrant testing:
The procedure for APC gene analysis involves several key steps to ensure accurate identification of mutations:
After the APC gene analysis is completed, patients may receive genetic counseling to discuss the results and their implications. If a mutation is identified, the healthcare provider may recommend regular surveillance for colorectal cancer, including colonoscopies at appropriate intervals, to monitor for the development of polyps or cancer. Additionally, family members may be advised to undergo testing to determine their risk of inheriting the mutation. It is essential for patients to understand the significance of the results and the potential need for lifestyle modifications or preventive measures based on their genetic risk.
| Short Descr | APC GENE FULL SEQUENCE | Medium Descr | APC GENE ANALYSIS FULL GENE SEQUENCE | Long Descr | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 234 - Pathology |
This is a primary code that can be used with these additional add-on codes.
| 0157U | Add-on Code APC A APC (APC regulator of WNT signaling pathway) (eg, familial adenomatosis polyposis [FAP]) mRNA sequence analysis (List separately in addition to code for primary procedure) |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition |
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| 2013-01-01 | Added | Added |
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