How To Use CPT Code 81230

CPT 81230 describes the analysis of common variants of the CYP3A4 gene, such as *2 and *22. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81230?

CPT 81230 can be used to analyze the common variants of the CYP3A4 gene, specifically *2 and *22. This code is used when a lab analyst performs the technical steps to extract nucleic acids, amplify the gene, and detect the target genes using methods such as nucleic acid probes. The analysis of these common variants helps evaluate therapeutic drug dosing for certain medications, as the CYP3A4 gene is involved in the metabolism of certain drugs and can affect their bioavailability.

2. Official Description

The official description of CPT code 81230 is: ‘CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22).’

3. Procedure

1. The lab analyst performs the technical steps to extract nucleic acids from a specimen, such as blood.
2. The extracted nucleic acids are amplified to increase and stabilize the quantity of the CYP3A4 gene for analysis.
3. The lab analyst detects the common variants of the CYP3A4 gene, such as *2 and *22, using methods such as nucleic acid probes.

4. Qualifying circumstances

CPT 81230 is used when analyzing the common variants of the CYP3A4 gene, such as *2 and *22. This analysis is not limited to testing for a specific condition but is commonly ordered by clinicians to help evaluate therapeutic drug dosing for medications metabolized by the CYP3A4 gene. The analysis is performed by a lab analyst using methods such as nucleic acid probes.

5. When to use CPT code 81230

CPT code 81230 should be used when analyzing the common variants of the CYP3A4 gene, such as *2 and *22, to evaluate therapeutic drug dosing for certain medications. It is not limited to testing for a specific condition but is commonly ordered by clinicians. This code should not be used for other gene analyses or when analyzing different variants of the CYP3A4 gene.

6. Documentation requirements

To support a claim for CPT 81230, the documentation should include:

• Indication for the analysis of common variants of the CYP3A4 gene
• Details of the technical steps performed by the lab analyst, including extraction, amplification, and detection methods
• Specimen used for the analysis

7. Billing guidelines

When billing for CPT 81230, ensure that the analysis is performed by a lab analyst using methods such as nucleic acid probes. It is important to note that some payers may separately reimburse for specimen collection using a different code, such as 36415. Additionally, if the ordering clinician requests physician interpretation of the test and the pathologist provides an interpretation and report, you may report G0452 with modifier 26 to Medicare and other payers, as long as an MD or DO physician performs the interpretation.

8. Historical information

CPT 81230 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the analysis of common variants of the CYP3A4 gene, such as *2 and *22, to evaluate therapeutic drug dosing for a patient taking statins to treat high cholesterol.
2. The analysis of the CYP3A4 gene variants is performed to assess the metabolism of certain medications for a patient with a complex medication regimen.
3. A clinician orders the analysis of common variants of the CYP3A4 gene to determine the appropriate dosage of a medication metabolized by this gene for a patient with liver disease.
4. The analysis of the CYP3A4 gene variants is performed to guide the selection and dosing of medications for a patient with multiple comorbidities.
5. A lab analyst analyzes the common variants of the CYP3A4 gene to evaluate the potential drug interactions and adverse effects for a patient taking multiple medications.
6. The analysis of the CYP3A4 gene variants is performed to optimize the therapeutic drug dosing for a patient undergoing chemotherapy.
7. A clinician orders the analysis of common variants of the CYP3A4 gene to assess the metabolism of a specific medication for a patient with a history of poor drug response.
8. The analysis of the CYP3A4 gene variants is performed to personalize the medication regimen for a patient with a genetic predisposition to altered drug metabolism.
9. A lab analyst analyzes the common variants of the CYP3A4 gene to evaluate the potential drug-drug interactions for a patient with multiple chronic conditions.
10. The analysis of the CYP3A4 gene variants is performed to guide the selection and dosing of medications for a patient with a history of adverse drug reactions.