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The CPT® Code 81226 pertains to the molecular genetic testing of the CYP2D6 gene, which is located on chromosome 22. This gene encodes for the cytochrome P450, family 2, subfamily D, polypeptide 6, a crucial enzyme involved in the metabolism of various xenobiotics, including drugs and toxins. The CYP2D6 enzyme plays a significant role in the mixed function oxidase system, which is responsible for the bioactivation and synthesis of essential substances such as cholesterol, steroids, and other lipids. Due to genetic polymorphism, there is considerable variability in how individuals metabolize drugs, which can lead to different therapeutic outcomes. The common variants of the CYP2D6 gene are classified into several categories based on their functionality: normal-fully functional variants (*1, *2, with exceptions for *1xN and *2xN), partial functioning-decreased variants (*9, *10, *17, *29, *41), partial functioning-increased variants (*1xN, *2xN), and non-functioning variants (*3, *4, *5, *6, *19, *4xN). This genetic testing is particularly relevant for patients undergoing specific drug therapies, such as Tamoxifen for breast cancer, as it helps identify mutations that may affect drug metabolism, potentially leading to adverse drug responses or effects.
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The molecular genetic testing for CYP2D6 gene analysis is indicated for individuals who may be undergoing drug therapies that are significantly influenced by the metabolism of the CYP2D6 enzyme. This includes patients who are prescribed medications such as Tamoxifen, which is commonly used in the treatment of breast cancer. The testing is essential for identifying specific gene mutations that could alter the metabolism of these drugs, thereby impacting their efficacy and safety.
The procedure for CYP2D6 gene analysis involves several key steps to ensure accurate testing and 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 variants of the CYP2D6 gene. This process may include techniques such as polymerase chain reaction (PCR) and sequencing to detect the presence of common variants, including *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, and *4XN. 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 healthcare provider, who can use it to make informed decisions regarding the patient's medication management.
After the CYP2D6 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 review the test results thoroughly and discuss the implications with the patient. This may include explaining how the identified gene variants could affect the patient's response to certain medications and the potential need for dosage adjustments or alternative therapies. Continuous monitoring of the patient's response to treatment may also be recommended, especially if they are on medications that are metabolized by the CYP2D6 enzyme. Additionally, the healthcare provider may consider genetic counseling for the patient to provide further insights into the results and their significance in the context of personalized medicine.
| Short Descr | CYP2D6 GENE COM VARIANTS | Medium Descr | CYP2D6 GENE ANALYSIS COMMON VARIANTS | Long Descr | CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN) | 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 |
| 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 | 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. | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GA | Waiver of liability statement issued as required by payer policy, individual case | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | 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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