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The CPT® Code 81298 pertains to the molecular genetic testing of the MSH6 gene, which is crucial for identifying specific mutations that may increase an individual's risk of developing hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome. The MSH6 gene is located on chromosome 2 and plays a vital role in the DNA repair process. It is part of a protein complex that works alongside the MSH1/PMS2 complex to detect and correct errors that occur during DNA replication. When these errors are not repaired, they can accumulate over time, leading to uncontrolled cell growth and the formation of tumors. HNPCC is the most prevalent cancer associated with mutations in the MSH6 gene, but such mutations can also lead to cancers in other organs, including the endometrium, ovaries, prostate, stomach, small intestine, liver, gallbladder duct, upper urinary tract, brain, and skin. The presence of MSH6 mutations is particularly significant in individuals with Lynch syndrome, which is found in approximately 10 percent of those diagnosed with HNPCC. This condition is characterized by an increased risk of developing various cancers, particularly colorectal and endometrial cancers, often at an older age. The MSH6 gene mutation is associated with a higher incidence of endometrial cancers compared to mutations in other related genes, such as MLH1 and MSH2. Additionally, specific mutations have been identified with greater frequency in Ashkenazi Jewish populations, with affected individuals typically experiencing the onset of tumors later in life. The full sequence analysis performed under CPT® Code 81298 involves comparing segments of the MSH6 gene to identify any mutations, including point mutations or single nucleotide polymorphisms, which are the most common types of alterations observed. This analysis is essential for understanding the genetic predisposition to cancer and guiding further testing and counseling for family members who may also be at risk.
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The MSH6 gene analysis (CPT® Code 81298) is indicated for individuals who may be at increased risk of hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome. The following conditions and circumstances warrant this genetic testing:
The procedure for MSH6 gene analysis involves several key steps to ensure accurate identification of mutations. The following procedural steps are performed:
After the MSH6 gene analysis is completed, several post-procedure considerations are important for patient care. Patients will receive the results of their genetic testing, which may indicate the presence of mutations associated with an increased risk of cancer. If a mutation is identified, genetic counseling is recommended to discuss the implications of the results, potential surveillance strategies, and options for family testing. Individuals who test positive for MSH6 mutations may be advised to undergo regular screenings and preventive measures to monitor for the development of cancers associated with Lynch syndrome. Additionally, family members may be encouraged to participate in genetic testing to determine their own risk status. It is essential for patients to have access to appropriate clinical supervision and support following the results of their genetic analysis.
| Short Descr | MSH6 GENE FULL SEQ | Medium Descr | MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS | Long Descr | MSH6 (mutS homolog 6 [E. coli]) (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.
| 0160U | Add-on Code APC A MSH6 (mutS homolog 6) (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) |
| 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. | 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 | 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. | 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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