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The CPT® Code 81292 pertains to the molecular genetic testing of the MLH1 gene, which is crucial for identifying mutations that increase the risk of developing colorectal cancer and other associated cancers. The MLH1 gene, located on chromosome 3, plays a vital role in encoding proteins responsible for DNA repair. When mutations occur in this gene, they can either prevent the production of the MLH1 protein or alter its structure, impairing its ability to function effectively. This impairment leads to the accumulation of unrepaired DNA errors, which can result in uncontrolled cell proliferation and the formation of tumors. The most prevalent condition associated with MLH1 mutations is hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome. This condition significantly elevates the risk of various cancers, including those of the endometrium, ovaries, prostate, stomach, small intestine, liver, gallbladder duct, upper urinary tract, brain, and skin. The full sequence analysis performed under CPT® Code 81292 involves a comprehensive examination of the MLH1 gene to identify specific mutations, including point mutations or single nucleotide polymorphisms, which are the most common types of alterations found in this gene. Additionally, when a mutation is identified in an individual, it is recommended that family members undergo genetic testing to assess the presence of familial variants, thereby aiding in the evaluation of cancer risk among relatives.
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The MLH1 gene analysis is indicated for individuals who may be at increased risk of hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome. The following conditions warrant this genetic testing:
The procedure for MLH1 gene analysis involves several key steps to ensure accurate identification of mutations:
After the MLH1 gene analysis is completed, individuals may receive counseling regarding the results. If a mutation is identified, genetic counseling is recommended for both the individual and their family members to discuss the implications of the findings, potential cancer risks, and options for surveillance or preventive measures. It is important for family members to consider testing for familial variants to understand their own risk factors. Follow-up appointments may be scheduled to discuss the results in detail and to plan any necessary medical management or screening protocols based on the findings.
| Short Descr | MLH1 GENE FULL SEQ | Medium Descr | MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS | Long Descr | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence 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 |
This is a primary code that can be used with these additional add-on codes.
| 0158U | Add-on Code APC A MLH1 (mutL homolog 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) | 0162U | Add-on Code APC A Hereditary colon cancer (Lynch syndrome), targeted mRNA sequence analysis panel (MLH1, MSH2, MSH6, PMS2) (List separately in addition to code for primary procedure) |
| XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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 | 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. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider |
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| 2012-01-01 | Added | Added |
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