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The CPT® Code 81218 pertains to the molecular genetic testing of the CEBPA gene, which is crucial for understanding certain types of acute myeloid leukemia (AML). This test involves a comprehensive analysis of the full gene sequence of CEBPA, which is located on the q arm of chromosome 19 at position 13.1. The primary purpose of this genetic analysis is to identify mutations within the CEBPA gene, including substitutions, insertions, and deletions. These mutations can significantly impact the diagnosis and prognosis of acute myeloid leukemia, as they help in assigning a specific sub-classification of the disease. The CEBPA gene encodes for the CCAAT/enhancer binding protein alpha, a transcription factor that plays a vital role in regulating gene expression by binding to specific DNA regions. This protein is essential for the maturation and differentiation of blood cells and acts as a tumor suppressor, controlling the growth and division of these cells. In cases of familial acute myeloid leukemia, certain inherited mutations in the CEBPA gene can disrupt normal blood cell production, leading to the disease. Notably, only one mutated copy of the gene is sufficient to cause familial AML, although it often coexists with additional somatic mutations in leukemic cells. Both inherited and sporadic forms of AML associated with CEBPA mutations can result in cytogenetically normal acute myeloid leukemia (CN-AML). The identified mutations typically lead to the production of an abnormally short protein that compromises the tumor suppressor functions of the normal CCAAT/enhancer binding protein alpha, thereby impairing its ability to regulate gene expression and resulting in the overproduction of abnormal white blood cells. The testing process involves obtaining blood and/or bone marrow samples, which are then analyzed for gene mutations using advanced techniques such as polymerase chain reaction (PCR) combined with massively parallel sequencing and genomic microarray methodologies.
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The CEBPA gene analysis (CPT® Code 81218) is indicated for the following conditions:
The procedure for conducting the CEBPA gene analysis involves several critical steps to ensure accurate results. First, a sample of blood and/or bone marrow is obtained from the patient. This is typically done through a venipuncture for blood samples or a bone marrow aspirate, both of which are separately reportable procedures. Once the samples are collected, they are prepared for analysis. The next step involves the extraction of DNA from the collected samples. Following DNA extraction, the full gene sequence of the CEBPA gene is analyzed using polymerase chain reaction (PCR) techniques. This method amplifies the specific regions of the gene of interest, allowing for detailed examination. The analysis is further enhanced by employing massively parallel sequencing, which enables the simultaneous sequencing of multiple DNA fragments, thereby providing a comprehensive view of the gene's structure. Additionally, genomic microarray techniques may be utilized to detect any deletions or duplications within the gene. The combination of these advanced molecular techniques allows for the identification of various mutations, including substitutions, insertions, and deletions, that may be present in the CEBPA gene.
After the CEBPA gene analysis is completed, the results are interpreted by a qualified healthcare professional. The findings can provide critical information regarding the presence of specific mutations that may influence the treatment plan and prognosis for the patient with acute myeloid leukemia. It is essential for healthcare providers to discuss the results with the patient, including the implications of any identified mutations on their condition and potential treatment options. Follow-up care may include additional testing or monitoring based on the results of the gene analysis, and healthcare providers should ensure that patients receive appropriate support and information regarding their diagnosis and treatment pathway.
| Short Descr | CEBPA GENE FULL SEQUENCE | Medium Descr | CEBPA GENE ANALYSIS FULL GENE SEQUENCE | Long Descr | CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), 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 |
| 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2016-01-01 | Added | Added |
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