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The CPT® Code 81328 pertains to the gene analysis of the SLCO1B1 gene, which is part of the solute carrier organic anion transporter family. This analysis focuses on identifying common variants, such as the *5 variant, which can have significant implications for drug metabolism and the risk of adverse drug reactions. The SLCO1B1 gene plays a crucial role in encoding a liver-specific protein responsible for the transport of various molecules, including bilirubin, hormones, toxins, and a range of medications, particularly statins, antibiotics, and chemotherapy agents, to the liver for detoxification and elimination from the body. This gene is situated on the short (p) arm of chromosome 12 at position 12.1. The most prevalent variant of this gene involves a substitution where the amino acid valine at position 174 is replaced by alanine, denoted as V174A or SLCO1B1*5. This specific variant is notably associated with an increased risk of statin-induced myopathy, a condition characterized by muscle pain, weakness, and cramping. The analysis of this gene can help determine an individual's risk for experiencing adverse reactions to statins based on their genetic makeup. For instance, individuals with two valine alleles (T/T) typically exhibit normal protein function and a very low risk for adverse drug reactions. In contrast, those with a valine/alanine genotype (T/C) may experience decreased drug metabolism, placing them at a higher risk for statin-induced myopathy. Furthermore, individuals with the alanine/alanine genotype (C/C) show markedly decreased drug metabolism and are at a significantly elevated risk for this condition. The identification of these genetic variants through testing can guide healthcare providers in selecting the most appropriate statin medication and dosage for patients, as well as in monitoring potential side effects. The testing process involves obtaining a blood sample, which is analyzed using real-time polymerase chain reaction (RT-PCR) techniques to detect the presence of these genetic variants.
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The gene analysis for SLCO1B1 (solute carrier organic anion transporter family, member 1B1) is indicated for the following conditions:
The procedure for conducting the SLCO1B1 gene analysis involves several key steps:
Post-procedure care primarily involves the interpretation of the test results and their implications for the patient's medication management. Healthcare providers will review the genetic findings to assess the patient's risk for statin-induced myopathy. Based on the results, providers may tailor the choice of statin medication and dosage to minimize the risk of adverse effects. Additionally, patients may be monitored for any symptoms of muscle pain, weakness, or cramping following the initiation of statin therapy, ensuring timely intervention if adverse reactions occur. Follow-up consultations may be scheduled to discuss the results and adjust treatment plans as necessary.
| Short Descr | SLCO1B1 GENE COM VARIANTS | Medium Descr | SLCO1B1 GENE ANALYSIS COMMON VARIANTS | Long Descr | SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5) | 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 |
| 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. | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2018-01-01 | Added | Code Added. |
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