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The CPT® Code 81236 pertains to the molecular genetic testing of the EZH2 gene, which stands for enhancer of zeste 2 polycomb repressive complex 2 subunit. This testing involves a comprehensive analysis of the full gene sequence associated with specific hematological disorders, namely myelodysplastic syndrome (MDS) and myeloproliferative neoplasms (MPN). The EZH2 gene is situated on the long (q) arm of chromosome 7 at the position designated as 7q36.1. It encodes for an enzyme known as histone methyltransferase, which plays a crucial role in modifying histone proteins through the addition of methyl groups. This methylation process can enhance the function of these proteins or lead to atypical functions that disrupt the normal regulatory mechanisms of cell division and proliferation. Consequently, this disruption can result in uncontrolled cell division, while simultaneously suppressing the self-renewal and differentiation of cells. MDS and MPN are conditions that arise when the bone marrow is unable to produce sufficient quantities of healthy blood cells, including red blood cells, white blood cells, and platelets. These disorders are characterized by the presence of an excessive number of blast cells and the production of underdeveloped or immature blood cells that exhibit abnormal shapes, sizes, or characteristics. Patients suffering from these conditions may experience a range of symptoms, including fatigue, weight loss, pallor, tachycardia, respiratory difficulties, fever, increased susceptibility to infections, bruising, abnormal bleeding, and the appearance of petechiae. The analysis performed under code 81236 involves a detailed examination of the EZH2 gene's full sequence, allowing for the comparison of gene segments to identify similarities or differences, as well as to establish relationships. This genetic testing can uncover specific genetic markers by detecting point mutations or single nucleotide polymorphisms, which are critical for understanding the underlying genetic factors associated with these hematological disorders.
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The molecular genetic testing for the EZH2 gene analysis is indicated for the following conditions:
The procedure for conducting the EZH2 gene analysis involves several key steps:
After the EZH2 gene analysis is completed, the patient may not require any specific post-procedure care related to the genetic testing itself. However, it is essential for healthcare providers to discuss the results with the patient, including any implications for diagnosis, treatment options, and potential follow-up testing. Patients may also need to be monitored for symptoms related to MDS or MPN, and any necessary interventions should be planned based on the findings of the genetic analysis. Additionally, genetic counseling may be recommended to help patients understand the significance of the results and the potential impact on family members.
| Short Descr | EZH2 GENE FULL GENE SEQUENCE | Medium Descr | EZH2 GENE ANALYSIS FULL GENE SEQUENCE | Long Descr | EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) 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) | none | 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. | GW | Service not related to the hospice patient's terminal condition | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2019-01-01 | Added | Added |
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