Basics about BRCA1 and BRCA2 CPT codes

BRCA1 is a gene within a class of genes that are known as tumor suppressors. Mutations of the BRCA1 gene have been linked to hereditary breast and ovarian cancers. Specimen is blood. This test is performed to determine what, if any, mutations have affected the BRCA1 gene.

The codes are selected depending on the type of mutation for which the test is performed.

BRCA1 & BRCA2 genes can help in repairing the damaged DNA (deoxyribonucleic acid). Most of the cancers happened due to the mutation of genes. Here also, the risk of breast and ovarian cancer increases with the genetic mutations.

As per the research study, approximately 72 percent of women who inherit a BRCA1 mutation and approximately 69 percent of women who inherit BRCA2 mutation will develop breast cancer by the age of 80.

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Description CPT codes for BRCA1, BRCA2

81211 (deleted) BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb)

CPT code 81211 is deleted in 2019, medical coders needs to now use CPT codes 81162, 81163 & 81164, instead of 81211 from 2019. Also, other related  CPT codes are 81165, 81166 & 81167  for BRCA1 & BRCA2.

81162  BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)

81163  ; full sequence analysis

81164  ; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81165  BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis

81166  BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81167  BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81212 (revised) 185delAG, 5385insC, 6174delT variants

81213 (deleted) uncommon duplication/deletion variants (deleted in 2019)

81214 (deleted) BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb) (deleted in 2019)

81215  BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant

81216  BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis

81217 known familial variant

A positive BRCA result does not mean the patient has cancer , only that she is at increased risk of developing certain kinds of cancer.

BRCA1 and/or 2 positive results are assigned with Z15.01 or Z15.02 depending on family history.

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Do and Don’t with CPT codes BRCA1, BRCA2 

Do not report 81163 in conjunction with 81162, 81164, 81165, 81216, 81432

Do not report 81164 in conjunction with 81162, 81163, 81166, 81167, 81217

Do not report 81165 in conjunction with 81162, 81163, 81432

Do not report 81166 in conjunction with 81162, 81164

Do not report 81216 in conjunction with 81162

Do not report 81167 in conjunction with 81162, 81164, 81217

Do not report 81217 in conjunction with 81162, 81164, 81167

How to take precautionary measure towards breast cancer

Having screening mammogram once in a year will surely help to detect any abnormal finding in the breast region. The early detection of sign and symptoms for breast cancer can help to treat the cancer effectively.

Even diagnostic mammogram can help to find the nature of abnormal mass or cell present in breast area. The final confirmation about cancerous cells can only be made through the cytological or pathological examination of abnormal cells.

References:

https://www.uofmhealth.org/health-library/

https://ww5.komen.org/BreastCancer/BRCA1andBRCA2

https://www.cgsmedicare.com/partb/pubs/news/2014/1114/cope27478

http://labguide.fairview.org/showTest.asp?testid=