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The CPT® Code 81225 pertains to the molecular genetic testing of the CYP2C19 gene, which is located on chromosome 10. This gene encodes for the cytochrome P450, family 2, subfamily C, polypeptide 19, a crucial enzyme involved in the metabolism of various xenobiotics, including drugs and toxins. The enzyme plays a significant role in the bioactivation and synthesis of essential substances such as cholesterol, steroids, and other lipids. Due to genetic polymorphisms, there is considerable variability in how individuals metabolize drugs, which can lead to different responses to medications. The common variants of the CYP2C19 gene are classified based on their functional capacity: the normal variant (*1) is fully functional, while variants such as *2 and *3 are associated with decreased or non-functioning enzyme activity. Other variants, including *4, *5, *6, *7, and *8, indicate decreased or partial enzyme function, whereas variant *17 is linked to increased partial function. This genetic testing is particularly relevant for patients undergoing specific drug therapies, such as those involving antiepileptics, proton pump inhibitors, and antidepressants, as it helps identify mutations that may affect drug metabolism and lead to adverse drug reactions or effects.
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The molecular genetic testing for CYP2C19 is indicated for individuals who are undergoing specific drug therapies that may be influenced by the metabolism of the CYP2C19 enzyme. This includes patients who are prescribed:
The procedure for conducting the CYP2C19 gene analysis involves several key steps to ensure accurate results. First, a sample is collected from the patient, typically through a blood draw or saliva sample, which contains the DNA necessary for analysis. Next, the laboratory performs a molecular genetic test to identify specific mutations within the CYP2C19 gene. This testing focuses on common variants such as *2, *3, *4, *8, and *17, which are known to influence the enzyme's functionality. The laboratory utilizes techniques such as polymerase chain reaction (PCR) and sequencing to detect these variants. Once the analysis is complete, the results are interpreted by a qualified geneticist or laboratory professional, who will provide a report detailing the identified variants and their potential implications for drug metabolism. This information is then communicated to the prescribing physician, who can use it to make informed decisions regarding the patient's medication regimen.
After the CYP2C19 gene analysis is completed, the patient may not require any specific post-procedure care, as the testing is non-invasive and does not involve any surgical intervention. However, it is essential for the healthcare provider to discuss the results with the patient, explaining how the identified genetic variants may impact their medication therapy. This discussion may include recommendations for adjusting dosages, selecting alternative medications, or monitoring for potential adverse drug reactions based on the patient's genetic profile. Additionally, patients should be encouraged to maintain open communication with their healthcare team regarding any new symptoms or concerns that may arise following changes to their medication regimen.
| Short Descr | CYP2C19 GENE COM VARIANTS | Medium Descr | CYP2C19 GENE ANALYSIS COMMON VARIANTS | Long Descr | CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17) | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 234 - Pathology |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GA | Waiver of liability statement issued as required by payer policy, individual case | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2012-01-01 | Added | Added |
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