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The CPT® Code 81203 pertains to the molecular genetic testing specifically aimed at identifying duplication and deletion variants of the adenomatous polyposis coli (APC) gene. This gene is crucial in the context of 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, many of which result in a truncated, nonfunctional APC protein. The testing associated with CPT® Code 81203 is essential for detecting specific genetic alterations that may predispose individuals to colorectal cancer, thereby facilitating early intervention and management strategies. This code is specifically used for testing that identifies duplication or deletion variants, which are critical for understanding the genetic basis of the disease and for guiding patient care.
© Copyright 2025 Coding Ahead. All rights reserved.
The molecular genetic testing represented by CPT® Code 81203 is indicated for individuals who are suspected of having familial adenomatosis polyposis (FAP) due to a family history of the condition or the presence of multiple colorectal polyps. This testing is particularly relevant for:
The procedure for CPT® Code 81203 involves several key steps to accurately identify duplication and deletion variants of the APC gene:
After the completion of the genetic testing associated with CPT® Code 81203, patients may receive counseling regarding the results. If a mutation is identified, genetic counseling is recommended to discuss the implications for the patient and their family members, including the risk of developing colorectal cancer and the need for surveillance or preventive measures. Patients may also be advised on lifestyle modifications and screening protocols based on their genetic risk. Follow-up appointments may be scheduled to monitor the patient's health and to discuss any further testing or interventions that may be necessary.
| Short Descr | APC GENE DUP/DELET VARIANTS | Medium Descr | APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS | Long Descr | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants | 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) | T2D - Other tests - other | MUE | 1 | CCS Clinical Classification | 234 - Pathology |
| 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. | 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. |
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| 2013-01-01 | Added | Added |
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