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The CPT® Code 81306 pertains to the molecular genetic testing of the NUDT15 (nudix hydrolase 15) gene, specifically focusing on the identification of common variants such as *2, *3, *4, *5, and *6. This gene analysis is crucial for understanding how certain individuals metabolize thiopurine drugs, which are commonly prescribed for various medical conditions, including malignant diseases like acute lymphoblastic leukemia, autoimmune disorders such as rheumatoid arthritis and inflammatory bowel disease, dermatological issues, and for solid organ transplant recipients to prevent organ rejection. The NUDT15 gene is situated on the long (q) arm of chromosome 13 at position 14.2 (13q14.2) and encodes an enzyme that plays a significant role in the metabolism of thiopurines. This enzyme is part of the nudix hydrolase superfamily and is responsible for dephosphorylating the active metabolites of thiopurines, namely thioguanosine triphosphate (TGTP) and deoxy-thioguanosine triphosphate (TdGTP). By doing so, it prevents these drugs from being incorporated into cells, thereby reducing their cytotoxic effects and overall efficacy in treatment. Variants in the NUDT15 gene are particularly prevalent among Asian, Hispanic, and Native American populations, and understanding these mutations is essential for optimizing thiopurine therapy and minimizing adverse drug reactions.
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The NUDT15 gene analysis (CPT® Code 81306) is indicated for patients who are being considered for thiopurine drug therapy. The following conditions and situations warrant this genetic testing:
The procedure for conducting the NUDT15 gene analysis involves several key steps to ensure accurate identification of the common variants associated with thiopurine metabolism:
After the NUDT15 gene analysis is completed, the healthcare provider will review the results with the patient. Depending on the identified variants, the provider may adjust the thiopurine drug dosage or consider alternative therapies to optimize treatment and minimize the risk of adverse effects. Patients may also be monitored for any side effects related to thiopurine therapy, and follow-up consultations may be scheduled to assess treatment efficacy and safety. It is essential for healthcare providers to communicate the significance of the genetic findings to the patient, ensuring they understand how these results may impact their treatment plan.
| Short Descr | NUDT15 GENE COMMON VARIANTS | Medium Descr | NUDT15 GENE ANALYSIS COMMON VARIANTS | Long Descr | NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6) | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2019-01-01 | Added | Added |
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