How To Use CPT Code 81350

CPT 81350 describes the analysis of the UGT1A1 gene for common variants, which can be used to assess drug metabolism and diagnose hereditary unconjugated hyperbilirubinemia, such as Gilbert syndrome. 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 81350?

CPT 81350 is a code used to describe the analysis of the UGT1A1 gene for common variants. This test is performed to assess drug metabolism and diagnose hereditary unconjugated hyperbilirubinemia, specifically Gilbert syndrome. It involves detecting the presence of common changes in the UGT1A1 gene, such as *28, *36, and *37 variants. The test may also include other non-listed variants.

2. Official Description

The official description of CPT code 81350 is: ‘UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) gene analysis, common variants (eg, *28, *36, *37).’ This code represents the testing for any of the more frequent changes in the UGT1A1 gene, known as common variants.

3. Procedure

1. The lab analyst performs the technical steps of the test, starting from extracting nucleic acids from a specimen, such as blood, using methods like cell lysis and digestion.
2. The lab analyst then amplifies the nucleic acids using techniques like polymerase chain reaction (PCR) to increase and stabilize the quantity of nucleic acid for analysis.
3. The target genes, specifically the UGT1A1 gene, are detected using methods such as nucleic acid probes.

4. Qualifying circumstances

CPT 81350 is typically ordered for individuals with cancer who are to receive a common cancer drug, such as irinotecan, or patients suspected of having hereditary unconjugated hyperbilirubinemia, like Gilbert syndrome. The test helps assess drug metabolism and diagnose conditions related to UGT1A1 gene variants.

5. When to use CPT code 81350

CPT code 81350 should be used when there is a need to analyze the UGT1A1 gene for common variants. This test is appropriate for assessing drug metabolism, especially for individuals receiving specific medications, and diagnosing hereditary unconjugated hyperbilirubinemia, such as Gilbert syndrome.

6. Documentation requirements

To support a claim for CPT 81350, the following documentation is required:

• Indication for the test, such as suspected hereditary unconjugated hyperbilirubinemia or need for drug metabolism assessment
• Specific variants tested, including *28, *36, and *37, and any additional non-listed variants
• Date of the test
• Results of the analysis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81350, ensure that the test is performed to analyze the UGT1A1 gene for common variants. It is important to distinguish this code from other codes that may involve different gene sequences or conditions. Additionally, consider reporting separate codes for specimen collection, if applicable, and physician interpretation of the test results.

8. Historical information

CPT 81350 was added to the Current Procedural Terminology system on January 1, 2012. On January 1, 2020, the code description was updated to include drug metabolism as an example of its application.

9. Examples

1. An individual with cancer is undergoing treatment with irinotecan, and the physician orders CPT 81350 to assess their UGT1A1 gene for common variants that may affect drug metabolism.
2. A patient presents with symptoms of hereditary unconjugated hyperbilirubinemia, and the physician orders CPT 81350 to diagnose the specific gene variants associated with the condition, such as Gilbert syndrome.
3. A clinician suspects a patient may have altered drug metabolism due to UGT1A1 gene variants and orders CPT 81350 to confirm the presence of common changes in the gene.
4. A newborn exhibits signs of jaundice, and the physician orders CPT 81350 to determine if the condition is caused by hereditary unconjugated hyperbilirubinemia, such as Gilbert syndrome.
5. A patient is scheduled to receive a medication known to be metabolized by the UGT1A1 enzyme, and the physician orders CPT 81350 to assess the patient’s ability to metabolize the drug effectively.
6. A family history of hereditary unconjugated hyperbilirubinemia raises concerns, and CPT 81350 is ordered to identify any common variants in the UGT1A1 gene that may be responsible.
7. A patient experiences adverse reactions to a specific medication, and CPT 81350 is ordered to investigate if UGT1A1 gene variants are contributing to the drug’s toxicity.
8. A clinician suspects a patient may have Gilbert syndrome based on symptoms and orders CPT 81350 to confirm the diagnosis by analyzing the UGT1A1 gene for common variants.