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The CPT® Code 81295 pertains to the molecular genetic testing of the MSH2 gene, which is crucial for identifying mutations that increase the risk of developing colorectal cancer and other associated cancers. The MSH2 gene is located on chromosome 2 and plays a significant role in the DNA repair process. It is part of a protein complex that detects errors during DNA replication, working in conjunction with the MSH1/PMS2 protein complex to facilitate necessary repairs. When these errors are not corrected, they can accumulate, leading to uncontrolled cell proliferation and the formation of tumors. The most notable condition associated with mutations in the MSH2 gene is hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome. This condition is characterized by a heightened 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 81295 involves a comprehensive examination of the MSH2 gene to identify specific mutations, particularly point mutations, which are alterations in a single DNA base. This analysis is essential for individuals with a family history of MSH2 mutations, as it can guide further testing and counseling for family members who may also be at risk.
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Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Genetic testing is indicated for individuals with a family history of HNPCC or Lynch syndrome, as they are at an increased risk of developing colorectal and other associated cancers.
Family Members of Affected Individuals Testing is also indicated for family members of individuals who have been identified with a mutation in the MSH2 gene to determine their risk status and guide clinical management.
Full Sequence Analysis The procedure begins with the collection of a blood or tissue sample from the individual being tested. The sample is then processed to extract DNA, which is subsequently analyzed for mutations in the MSH2 gene. Full sequence analysis involves comparing the gene segments to identify any variations or mutations. This detailed examination allows for the detection of point mutations, which are changes in a single nucleotide base within the DNA sequence. The results of this analysis will indicate whether a mutation is present, which can inform the individual and their healthcare providers about the potential risk of developing associated cancers.
After the completion of the MSH2 gene analysis, individuals will receive their results, which may take several weeks. If a mutation is identified, it is recommended that family members undergo genetic testing to assess their risk. Those who test positive for the mutation should be counseled regarding their increased cancer risk and may be offered clinical supervision, including regular screenings and preventive measures. It is essential for individuals to discuss the implications of the test results with a healthcare professional who specializes in genetics to ensure appropriate follow-up care and support.
| Short Descr | MSH2 GENE FULL SEQ | Medium Descr | MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS | Long Descr | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (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.
| 0159U | Add-on Code APC A MSH2 (mutS homolog 2) (eg, hereditary colon 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) |
| 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2012-01-01 | Added | Added |
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