How To Use CPT Code 81231

CPT 81231 describes the analysis of common variants of the CYP3A5 gene, which is involved in drug metabolism. 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 81231?

CPT 81231 can be used to analyze the common variants of the CYP3A5 gene, which plays a role in drug metabolism. This code is used when the lab analyst performs the technical steps to extract nucleic acids, amplify the gene, and detect the target genes using a specimen such as blood. The analysis focuses on identifying variants such as *2, *3, *4, *5, *6, *7 of the CYP3A5 gene.

2. Official Description

The official description of CPT code 81231 is: ‘CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)’

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 CYP3A5 gene for analysis.
3. The lab analyst detects the common variants of the CYP3A5 gene, such as *2, *3, *4, *5, *6, *7, using methods like nucleic acid probes.

4. Qualifying circumstances

CPT 81231 is used when clinicians order the analysis of common variants of the CYP3A5 gene to evaluate therapeutic drug dosing for certain medications. The CYP3A5 gene is involved in the metabolism of drugs like tacrolimus, and variations in this gene can affect the bioavailability of the medication. This test is not limited to a specific condition and can be ordered by clinicians to assess drug metabolism in their patients.

5. When to use CPT code 81231

CPT code 81231 should be used when there is a clinical need to analyze the common variants of the CYP3A5 gene. It is appropriate to bill this code when the lab analyst performs the technical steps to extract nucleic acids, amplify the gene, and detect the common variants of the CYP3A5 gene using a specimen such as blood.

6. Documentation requirements

To support a claim for CPT 81231, the documentation should include:

• Reason for ordering the analysis of common variants of the CYP3A5 gene
• Details of the technical steps performed by the lab analyst, including nucleic acid extraction, amplification, and detection of the common variants
• Specimen used for the analysis, such as blood
• Results of the analysis, including the identification of the common variants of the CYP3A5 gene
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT 81231, ensure that the analysis is performed by a lab analyst and that the technical steps, including nucleic acid extraction, amplification, and detection of the common variants, are documented. It is important to note that some payers may separately reimburse for specimen collection using a code like 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 81231 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 performing the analysis of common variants of the CYP3A5 gene for a patient to evaluate therapeutic drug dosing.
2. An oncologist ordering the analysis of common variants of the CYP3A5 gene to assess drug metabolism in a patient receiving chemotherapy.
3. A transplant surgeon requesting the analysis of common variants of the CYP3A5 gene to determine the appropriate dosage of immunosuppressive medication for a patient.
4. A primary care physician ordering the analysis of common variants of the CYP3A5 gene to guide medication selection and dosing for a patient with multiple chronic conditions.
5. A pharmacist requesting the analysis of common variants of the CYP3A5 gene to optimize drug therapy for a patient with complex medication regimens.
6. A genetic counselor ordering the analysis of common variants of the CYP3A5 gene to assess drug metabolism in a patient with a known genetic disorder.
7. A rheumatologist requesting the analysis of common variants of the CYP3A5 gene to guide medication management for a patient with autoimmune disease.
8. An anesthesiologist ordering the analysis of common variants of the CYP3A5 gene to personalize anesthesia and pain management for a patient undergoing surgery.
9. A psychiatrist requesting the analysis of common variants of the CYP3A5 gene to optimize medication selection and dosing for a patient with mental health disorders.
10. A geriatrician ordering the analysis of common variants of the CYP3A5 gene to assess drug metabolism in an elderly patient with multiple comorbidities.