CPT® Code 88263

Official Description

Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding

Common Language Description

CPT® Code 88263 refers to a specific type of chromosome analysis that involves counting 45 cells to assess for mosaicism, along with the analysis of two karyotypes using banding techniques. This procedure is typically performed on samples obtained from peripheral blood lymphocytes, skin, or solid tissue, which must be cultured in a separately reportable procedure prior to analysis. Karyotyping is a critical evaluation method that examines the size, shape, and number of chromosomes present in the cell samples. The banding technique utilized in this analysis is essential for identifying individual chromosomes, as it produces distinct bands that allow for differentiation between them. One common method of banding is Giemsa banding, which involves a series of steps including acetic acid fixation, air drying, denaturing chromosomes through proteolytic enzymes or other techniques, and finally applying Giemsa stain. Alternatively, chromosome banding may also be conducted using fluorochrome and Q-banding stains. This analysis is particularly important for identifying any extra, missing, or abnormal chromosome segments. Normal karyotypes are characterized by 46 chromosomes, with females typically having a karyotype of 46 XX and males having 46 XY. The analysis performed under CPT® Code 88263 is crucial for detecting mosaicism, a condition where some cells exhibit a normal chromosome count while others may have abnormalities, such as an extra chromosome, known as trisomy. This condition can lead to various health issues, including mental retardation, congenital heart defects, and other physical anomalies. The requirement to analyze 45 cells is significant, as it allows for a more accurate diagnosis of mosaicism, which is the only definitive method for identifying this chromosomal condition.

1. Indications

The procedure associated with CPT® Code 88263 is indicated for the evaluation of individuals suspected of having chromosomal abnormalities, particularly those exhibiting signs of mosaicism. The following conditions may warrant this analysis:

Mosaicism - A condition where some cells have a normal chromosome count while others have abnormalities, which can lead to various health issues.
Trisomy Mosaicism - Specifically when certain chromosomes, such as chromosomes 9, 14, and 22, are affected, resulting in an extra chromosome in some cells.
Congenital Anomalies - Individuals presenting with congenital heart defects, abnormalities of skull and facial bones, or other musculoskeletal system anomalies.
Developmental Delays - Cases where mental retardation or other developmental delays are observed, prompting further genetic investigation.

2. Procedure

The procedure for CPT® Code 88263 involves several critical steps to ensure accurate chromosome analysis. The following procedural steps are outlined:

Sample Collection - The first step involves obtaining a sample from the patient, which may include peripheral blood lymphocytes, skin, or solid tissue. This sample is essential for the subsequent analysis.
Cell Culture - The collected sample is then cultured in a laboratory setting. This process is crucial as it allows for the growth of cells that will be analyzed. The culture must be performed in a separately reportable procedure to ensure proper documentation and billing.
Cell Identification - After sufficient growth, 45 cells are identified from the cultured sample. This number is specifically required to assess for mosaicism accurately.
Karyotype Analysis - Two karyotypes are analyzed using banding techniques. This involves applying chromosome staining methods, such as Giemsa banding, to visualize the chromosomes and identify any abnormalities.
Data Interpretation - The results of the karyotype analysis are interpreted to determine the presence of mosaicism or any chromosomal abnormalities. This step is critical for diagnosing conditions that may affect the patient’s health.

3. Post-Procedure

Post-procedure care following the chromosome analysis under CPT® Code 88263 typically involves monitoring the patient for any immediate reactions to the sample collection. Since the procedure primarily involves laboratory analysis, there are no specific recovery protocols required. However, healthcare providers may discuss the results with the patient once they are available, which can take several days to weeks. It is essential to provide the patient with information regarding the implications of the findings, especially if mosaicism or chromosomal abnormalities are detected. Follow-up consultations may be necessary to address any further testing or interventions based on the results of the analysis.

Short Descr	CHROMOSOME ANALYSIS 45
Medium Descr	CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE
Long Descr	Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding
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	Conditionally packaged laboratory tests
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	1
CCS Clinical Classification	206 - Microscopic examination (bacterial smear, culture, toxicology)

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
GZ	Item or service expected to be denied as not reasonable and necessary