How To Use CPT Code 81306

CPT 81306 describes the analysis of the NUDT15 gene for common variants, such as *2, *3, *4, *5, and *6, which are associated with 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 81306?

CPT 81306 is used to analyze the NUDT15 gene for common variants that are associated with drug metabolism. This test specifically targets variants such as *2, *3, *4, *5, and *6. It is performed by a lab analyst using a specimen, such as blood, to detect the presence of these specific genetic changes.

2. Official Description

The official description of CPT code 81306 is: ‘NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6).’ This code represents the analysis of the NUDT15 gene for common variants associated with drug metabolism.

3. Procedure

1. The lab analyst performs the technical steps of the test, starting from extracting the nucleic acids from the specimen, such as blood, using methods like cell lysis and digestion.
2. The lab analyst then amplifies the nucleic acids using a method like polymerase chain reaction (PCR) to increase and stabilize the quantity of nucleic acid for analysis.
3. The target genes, specifically the NUDT15 gene, are detected using techniques such as PCR.

4. Qualifying circumstances

CPT 81306 is ordered by clinicians when considering the use of thiopurines as therapeutic agents for patients who require treatment with anticancer or immunosuppressive drugs. This test helps identify common variants in the NUDT15 gene, which are associated with poor thiopurine metabolism and potential toxicity reactions. It is important to note that this test is not limited to a specific condition and can be ordered based on the clinician’s judgment and patient’s needs.

5. When to use CPT code 81306

CPT code 81306 should be used when analyzing the NUDT15 gene for common variants associated with drug metabolism. It is appropriate to use this code when the clinician suspects that the patient may have poor thiopurine metabolism and wants to assess the risk of toxicity reactions. This code should not be used for other genetic analyses or when analyzing different genes.

6. Documentation requirements

To support a claim for CPT 81306, the documentation should include:

• Reason for ordering the test, such as the consideration of thiopurine therapy
• Specific variants analyzed, such as *2, *3, *4, *5, and *6
• Date of the test
• Results of the analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81306, ensure that the test is performed by a lab analyst and that the specific variants analyzed are documented. It is important to note that some payers may separately reimburse for specimen collection using a code such as 36415. If the ordering clinician requests physician interpretation and the pathologist provides an interpretation and report, you may also report G0452 with modifier 26. However, the interpretation must be performed by an MD or DO physician, not a PhD laboratory scientist.

8. Historical information

CPT 81306 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders CPT 81306 to analyze the NUDT15 gene for common variants in a patient who requires thiopurine therapy.
2. A patient with a history of adverse reactions to thiopurine drugs undergoes CPT 81306 to assess their risk of toxicity based on NUDT15 gene variants.
3. A clinician orders CPT 81306 for a patient who needs immunosuppressive therapy and wants to determine their risk of poor thiopurine metabolism.
4. CPT 81306 is performed on a patient with cancer to assess their potential response to anticancer drugs based on NUDT15 gene variants.
5. A clinician orders CPT 81306 for a patient who is starting thiopurine therapy to ensure their safety and optimize drug metabolism.
6. A patient with a known NUDT15 gene variant undergoes CPT 81306 to monitor their drug metabolism and adjust their medication accordingly.
7. CPT 81306 is performed on a patient with inflammatory bowel disease to assess their risk of thiopurine toxicity based on NUDT15 gene variants.
8. A clinician orders CPT 81306 for a patient with autoimmune disease who requires immunosuppressive therapy and wants to assess their risk of poor drug metabolism.
9. A patient with a family history of adverse reactions to thiopurine drugs undergoes CPT 81306 to determine their risk based on NUDT15 gene variants.
10. CPT 81306 is performed on a patient with a known NUDT15 gene variant to monitor their drug metabolism and adjust their medication regimen as needed.