© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 81436 pertains to a specialized laboratory test designed to identify genetic mutations linked to hereditary colon cancer disorders. This test is particularly relevant for individuals diagnosed with certain types of cancer and their family members who may be at increased risk for developing hereditary colon cancers. The hereditary conditions covered by this code include familial adenomatosis polyposis, Lynch syndrome (also known as hereditary nonpolyposis colon cancer), PTEN hamartoma tumor syndrome, and Cowden syndrome. These disorders are characterized by specific genetic mutations that can lead to an elevated risk of developing various cancers. For instance, PTEN and Cowden syndrome are rare genetic conditions marked by the presence of multiple hamartomas—benign tumor-like growths that can occur in different parts of the body—alongside a heightened susceptibility to certain cancer types. To perform this genetic testing, a sample is collected from the patient, which can be obtained from blood, saliva, or stool, depending on the specific requirements of the test. The analysis involves genomic sequencing, which examines the genetic material comprehensively or nearly comprehensively. The panel specifically analyzes at least five critical genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11, among others. These genes are essential for understanding the genetic basis of the aforementioned hereditary conditions. The test utilizes advanced techniques such as next-generation sequencing or massively parallel sequencing, allowing for the detection of intragenic deletions or duplications at a single exon resolution. This level of detail is crucial for accurate diagnosis and risk assessment in patients and their families.
© Copyright 2025 Coding Ahead. All rights reserved.
The genetic testing represented by CPT® Code 81436 is indicated for individuals who have been diagnosed with hereditary colon cancer disorders or for family members who are at risk of developing such conditions. The specific indications include:
The procedure for conducting the genetic testing under CPT® Code 81436 involves several critical steps:
After the genetic testing procedure is completed, the results are typically analyzed and interpreted by a qualified geneticist or healthcare professional. Patients may receive counseling regarding the implications of the test results, particularly in relation to their cancer risk and potential preventive measures. Follow-up care may include discussions about surveillance strategies, lifestyle modifications, or further testing for family members based on the findings. It is essential for patients to understand the significance of their results and the potential impact on their health and that of their relatives.
| Short Descr | HEREDITARY COLON CA DSORDRS | Medium Descr | HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN | Long Descr | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11 | 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 | Not applicable/unspecified. |
| 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2024-12-31 | Deleted | Code Deleted. See 81479 |
| 2016-01-01 | Changed | Description Changed |
| 2015-01-01 | Added | Added |