© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 81231 pertains to the analysis of the CYP3A5 gene, which is part of the cytochrome P450 family, specifically the subfamily A member 5. This gene plays a crucial role in drug metabolism, influencing how the body processes various medications. The analysis focuses on identifying common genetic variants, such as *2, *3, *4, *5, *6, and *7, which can significantly affect an individual's response to drugs. The CYP3A5 gene is located on the long (q) arm of chromosome 7 at position 22.1. Understanding these genetic variants is essential for personalized medicine, as they can help predict the likelihood of adverse drug reactions in patients with a personal or family history of such events. For instance, individuals without variant alleles are typically expected to metabolize drugs at a standard rate, allowing for conventional dosing. Conversely, the presence of one or more variant alleles may suggest reduced enzyme activity, necessitating careful monitoring for potential drug toxicity. The gene analysis is performed using a sample obtained from peripheral blood or buccal mucosa, which is processed through multiplex polymerase chain reaction (PCR) and primer extensions to detect the specific variants associated with the CYP3A5 gene.
© Copyright 2025 Coding Ahead. All rights reserved.
The CYP3A5 gene analysis (CPT® Code 81231) is indicated for individuals who may have a personal or family history of adverse drug reactions. This genetic testing is particularly relevant for patients who are prescribed medications that are metabolized by the CYP3A5 enzyme, as understanding their genetic makeup can guide treatment decisions and dosing strategies.
The procedure for conducting the CYP3A5 gene analysis involves several key steps to ensure accurate results. First, a sample is collected from the patient, which can be either a peripheral blood sample or a buccal mucosa sample. This collection is performed as a separate reportable procedure. Once the sample is obtained, it is processed in the laboratory using multiplex polymerase chain reaction (PCR) techniques. This method allows for the simultaneous amplification of multiple DNA sequences, specifically targeting the common variants of the CYP3A5 gene. Following amplification, primer extensions are utilized to identify the presence of the specific genetic variants, such as *2, *3, *4, *5, *6, and *7. The results of this analysis provide critical information regarding the patient's potential drug metabolism capabilities, which can inform clinical decisions regarding medication management.
After the CYP3A5 gene analysis is completed, the results are interpreted to determine the presence or absence of the common variants. If no variant alleles are detected, it typically indicates that the patient is likely to metabolize drugs normally, allowing for standard dosing protocols. However, if one or more variant alleles are present, this may suggest decreased enzyme activity, which necessitates closer monitoring of the patient for potential drug toxicity. Healthcare providers may need to adjust medication dosages or select alternative therapies based on the genetic findings to ensure safe and effective treatment outcomes. Follow-up consultations may be required to discuss the implications of the test results and to develop an appropriate management plan tailored to the patient's genetic profile.
| Short Descr | CYP3A5 GENE COMMON VARIANTS | Medium Descr | CYP3A5 GENE ANALYSIS COMMON VARIANTS | Long Descr | CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7) | 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) | none | MUE | 1 |
| 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2018-01-01 | Added | Code Added. |
Get instant expert-level medical coding assistance.