How To Use CPT Code 81328

CPT 81328 describes the genetic analysis procedure for detecting specific changes in the solute carrier organic anion transporter family, member 1B1 (SLCO1B1) gene. 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 81328?

CPT 81328 can be used to identify common variants in the SLCO1B1 gene through genetic analysis. This code is used when the lab analyst performs the technical steps to detect specific changes in the gene, such as *5 variant.

2. Official Description

The official description of CPT code 81328 is: ‘SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5)’

3. Procedure

1. The lab analyst performs the technical lab test to detect the presence of specific changes in the SLCO1B1 gene for common variants, such as *5.
2. The lab analyst extracts the nucleic acids from the specimen, increases and stabilizes the quantity of nucleic acid for analysis, and detects the target genes using methods such as nucleic acid probes.
3. The specimen used for this analysis is typically blood.

4. Qualifying circumstances

CPT 81328 is ordered by clinicians to uncover a possible genetic basis for myopathy associated with cholesterol-lowering statin therapy or for risk assessment before starting statin therapy. It is not limited to testing for a specific condition.

5. When to use CPT code 81328

CPT code 81328 should be used when there is a need to analyze the SLCO1B1 gene for common variants, such as *5. It is appropriate to bill this code when the lab analyst performs the genetic analysis procedure to detect specific changes in the gene.

6. Documentation requirements

To support a claim for CPT 81328, the documentation should include:

• Reason for ordering the test and the clinical indication
• Details of the technical steps performed by the lab analyst
• Specimen used for the analysis

7. Billing guidelines

When billing for CPT 81328, ensure that the genetic analysis procedure is performed to detect specific changes in the SLCO1B1 gene. There are no specific guidelines regarding reporting this code with other codes. However, it is important to follow payer-specific guidelines and provide any necessary supporting documentation.

8. Historical information

CPT 81328 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 clinician orders CPT 81328 to analyze the SLCO1B1 gene for common variants in a patient experiencing myopathy associated with statin therapy.
2. A patient undergoes CPT 81328 to assess their risk for adverse drug reactions before starting statin therapy.
3. A clinician requests CPT 81328 to investigate the genetic basis of a patient’s cholesterol-lowering statin therapy-related side effects.
4. CPT 81328 is performed on a patient to determine their susceptibility to myopathy associated with specific cholesterol-lowering medications.
5. A clinician orders CPT 81328 to assess the patient’s genetic predisposition to adverse drug reactions related to statin therapy.
6. A patient undergoes CPT 81328 to identify common variants in the SLCO1B1 gene that may impact their response to cholesterol-lowering medications.
7. CPT 81328 is performed on a patient to evaluate their risk for myopathy associated with specific statin therapy.
8. A clinician requests CPT 81328 to analyze the SLCO1B1 gene for common variants in a patient with a family history of adverse drug reactions to cholesterol-lowering medications.
9. A patient undergoes CPT 81328 to determine their genetic susceptibility to myopathy associated with statin therapy.
10. CPT 81328 is performed on a patient to assess their risk for adverse drug reactions before initiating cholesterol-lowering statin therapy.