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The CPT® Code 81219 pertains to the molecular genetic testing of the CALR (calreticulin) gene, specifically focusing on common variants found in exon 9. This gene analysis is crucial for identifying mutations that may include substitutions, insertions, and deletions within the CALR gene, which is located on the p arm of chromosome 19, specifically between positions 13.3 and 13.2. The testing serves as a diagnostic medical marker for conditions such as essential thrombocytopenia (ET) and primary myelofibrosis (PMF). The CALR gene is responsible for encoding the calreticulin protein, which plays a vital role in various cellular functions, including the processing and transport of calcium ions within the endoplasmic reticulum (ER), as well as influencing gene activity, cell growth, proliferation, migration, adhesion, and apoptosis, which are essential processes in wound healing and immune system function. Mutations in the CALR gene are typically somatic, meaning they are not inherited but rather acquired during an individual's lifetime, occurring in only a subset of cells. These mutations, particularly those involving the addition or deletion of genetic material at exon 9, are notably associated with essential thrombocytopenia, a condition characterized by elevated platelet levels and disruptions in normal blood clotting mechanisms. Additionally, CALR gene mutations can also be present in patients diagnosed with primary myelofibrosis, a serious condition where the normal bone marrow is replaced by fibrotic scar tissue, leading to various hematological complications. The testing process involves obtaining blood and/or bone marrow samples, which are then analyzed for gene mutations using polymerase chain reaction (PCR) amplification and subsequent genetic analysis of the resulting fragments.
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The CALR gene analysis (CPT® Code 81219) is indicated for the following conditions:
The procedure for conducting the CALR gene analysis involves several key steps:
After the CALR gene analysis is completed, the results are interpreted by a qualified healthcare professional. The findings can provide valuable insights into the patient's condition, aiding in diagnosis and treatment planning. Patients may require follow-up consultations to discuss the implications of the test results, potential treatment options, and any necessary monitoring for associated conditions. It is important to ensure that all documentation related to the procedure and results is accurately maintained for compliance and billing purposes.
| Short Descr | CALR GENE COM VARIANTS | Medium Descr | CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 | Long Descr | CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9 | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2016-01-01 | Added | Added |
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