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The CPT® Code 81238 pertains to the analysis of the F9 gene, which is crucial for the production of coagulation factor IX, a protein that plays a vital role in the blood clotting process. This gene analysis is specifically designed to identify mutations within the full gene sequence of the F9 gene, which is located on the long (q) arm of the X chromosome at position 27.1. Coagulation factor IX is synthesized in the liver and remains inactive until it is needed for clot formation, particularly in response to injury. Upon activation by factor Xia, factor IX initiates a cascade of reactions involving various coagulation factors and molecules, ultimately leading to the sealing of damaged blood vessels and minimizing blood loss. The analysis of the F9 gene is particularly significant in the context of Hemophilia B, a bleeding disorder characterized by a deficiency of factor IX. This test can confirm a diagnosis of Hemophilia B in patients exhibiting symptoms such as spontaneous bleeding into joints or deep tissues, or it can be used to determine carrier status in females who have a family history of bleeding disorders but lack a known F9 genotype. The testing process involves obtaining a blood sample, which is then analyzed using polymerase chain reaction (PCR) amplification followed by fluorescent DNA full gene sequencing to detect any mutations present in the F9 gene.
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The F9 gene analysis (CPT® Code 81238) is indicated for the following conditions and scenarios:
The procedure for conducting the F9 gene analysis involves several key steps:
After the F9 gene analysis is completed, the results are interpreted by a qualified healthcare professional. The findings can provide critical information regarding the presence of mutations in the F9 gene, which can influence treatment decisions and management strategies for patients diagnosed with Hemophilia B. Patients may require counseling to understand the implications of their test results, especially in cases where carrier status is determined. Follow-up care may include discussions about potential treatment options, lifestyle modifications, and genetic counseling for family members.
| Short Descr | F9 FULL GENE SEQUENCE | Medium Descr | F9 FULL GENE SEQUENCE | Long Descr | F9 (coagulation factor IX) (eg, hemophilia B), 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 |
| 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. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GW | Service not related to the hospice patient's terminal condition | 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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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| 2018-01-01 | Added | Code Added. |
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