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The CPT® Code 81246 pertains to the molecular genetic testing of the FLT3 (fms-related tyrosine kinase 3) gene, specifically focusing on the analysis of tyrosine kinase domain (TKD) variants, such as D835 and I836. This gene is located on the q arm of chromosome 13 at position 12. The D835 variant is identified as a missense mutation occurring at the aspartic acid residue 835 and is found in approximately 7% of cases of acute myeloid leukemia (AML). AML is characterized by the clonal expansion of myeloid blast cells, which can infiltrate the blood, bone marrow, and other tissues, leading to a heterogeneous disease presentation. The identification of specific genetic variants within the FLT3 gene is crucial for personalizing treatment strategies, thereby enhancing the likelihood of achieving favorable patient outcomes. The FLT3 gene encodes a protein that is a member of the receptor tyrosine kinase (RTK) family, which plays a significant role in cellular signaling. These proteins interact with the FLT3 ligand on cell surfaces, triggering intracellular signaling pathways that regulate cell proliferation and survival, particularly in hematopoietic progenitor cells. To perform this genetic analysis, blood and/or bone marrow samples are collected, typically through venipuncture and/or bone marrow aspiration, which are separately reportable procedures. The testing for gene mutations is conducted using polymerase chain reaction (PCR) techniques, followed by amplification analysis through capillary electrophoresis to detect length mutations and assess resistance to EcoRV digestion.
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The molecular genetic testing represented by CPT® Code 81246 is indicated for the following conditions:
The procedure for conducting the molecular genetic testing for FLT3 gene variants involves several key steps:
After the completion of the molecular genetic testing, the results are interpreted by a qualified healthcare professional. The findings can provide critical information regarding the presence of FLT3 gene variants, which may influence treatment options and prognostic assessments for patients with acute myeloid leukemia. It is important for healthcare providers to discuss the results with the patient and consider them in the context of the overall treatment plan. Follow-up care may include additional testing or monitoring based on the results of the genetic analysis.
| Short Descr | FLT3 GENE ANALYSIS | Medium Descr | FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS | Long Descr | FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836) | 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 |
| 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. | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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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| 2015-01-01 | Added | Added |
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