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The CPT® Code 81263 pertains to the analysis of the immunoglobulin heavy chain locus (IGH@), specifically focusing on the variable region somatic mutation analysis. This molecular genetic testing is crucial for identifying specific gene mutations that are often associated with various hematological malignancies, including leukemia and lymphoma, particularly those of B-cell origin. The immunoglobulin heavy chain locus is located on chromosome 14 and plays a vital role in the immune system by producing immunoglobulins, which are essential for recognizing foreign antigens and initiating an immune response. Each immunoglobulin molecule is composed of two identical heavy chains and two identical light chains, which work together to form a functional antibody. During the development of B-cells, complete rearrangement of the IGH gene occurs in a stage-specific manner, allowing for the generation of diverse antibodies. Mutations within the IGH@ gene have been linked to various blood and lymphatic cancers, making this analysis particularly significant in the diagnostic and prognostic evaluation of these conditions. The variable region somatic mutation analysis involves extracting DNA from relevant cells or tissues, confirming clonality through a separately reportable polymerase chain reaction (PCR), and subsequently reamplifying the DNA using specific primers for the variable (V) heavy chain family. The resulting amplifications can then be sequenced and compared against control germline IGH V gene segments to identify any specific mutations present.
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The procedure associated with CPT® Code 81263 is indicated for the evaluation of specific gene mutations related to hematological malignancies. The following conditions may warrant this molecular genetic testing:
The procedure for CPT® Code 81263 involves several critical steps to ensure accurate analysis of the immunoglobulin heavy chain locus. The following outlines the procedural steps:
After the completion of the procedure associated with CPT® Code 81263, the results of the mutation analysis will be compiled and interpreted. The findings can provide significant insights into the presence of specific mutations associated with B-cell malignancies, aiding in the diagnosis and management of conditions such as leukemia and lymphoma. It is important for healthcare providers to discuss the results with the patient, as these findings may influence treatment decisions and prognostic assessments. Additionally, appropriate documentation of the procedure and results is essential for compliance and billing purposes.
| Short Descr | IGH VARI REGIONAL MUTATION | Medium Descr | IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS | Long Descr | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell), variable region somatic mutation analysis | 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 | CCS Clinical Classification | 234 - Pathology |
| 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. | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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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| 2012-01-01 | Added | Added |
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