CPT® Code 80335

Official Description

Antidepressants, tricyclic and other cyclicals; 1 or 2

Common Language Description

A laboratory test identified by CPT® Code 80335 is utilized to measure the levels of tricyclic and other cyclic antidepressants in biological samples such as urine, serum, or plasma. Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TeCAs) are classes of medications that primarily function by increasing the levels of certain neurotransmitters in the brain, specifically norepinephrine and serotonin, while simultaneously blocking the action of acetylcholine. These medications are commonly prescribed for a variety of conditions, including depression, anxiety disorders, fibromyalgia, chronic pain syndromes, and even for managing bedwetting in children. The tricyclic antidepressants include well-known drugs such as clomipramine (Anafranil), amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Pamelor), doxepin (Sinequan), and trimipramine (Surmontil). On the other hand, tetracyclic antidepressants encompass medications like amoxapine (Asendin), loxapine (Loxapac, Loxitan), mirtazapine (Remeron, Avinza), and maprotiline (Ludiomil). To perform the test, a blood sample is typically obtained through a procedure known as venipuncture, which is separately reportable. Alternatively, a urine sample can be collected either by random voiding or through catheterization. The testing process involves sophisticated techniques such as quantitative liquid chromatography-tandem mass spectrometry for all TCAs, high-performance liquid chromatography specifically for the TeCA loxapine, and quantitative gas chromatography for both maprotiline and mirtazapine. This code, 80335, is specifically designated for testing one or two cyclical antidepressants, while codes 80336 and 80337 are reserved for testing three to five and six or more compounds, respectively.

1. Indications

The laboratory test associated with CPT® Code 80335 is indicated for the measurement of tricyclic and other cyclic antidepressants in patients who may be undergoing treatment with these medications. The specific indications for this test include:

Depression: Patients diagnosed with major depressive disorder or other depressive conditions may require monitoring of their antidepressant levels to ensure therapeutic efficacy and safety.
Anxiety Disorders: Individuals suffering from anxiety disorders may be prescribed tricyclic antidepressants, necessitating regular testing to manage their treatment effectively.
Fibromyalgia: Patients with fibromyalgia may be treated with these medications, and monitoring their levels can help in adjusting dosages for optimal pain management.
Chronic Pain: Chronic pain conditions may be managed with tricyclic antidepressants, making it important to assess drug levels to avoid toxicity or subtherapeutic dosing.
Bedwetting: In pediatric patients, tricyclic antidepressants may be used to treat enuresis (bedwetting), and monitoring is essential to ensure appropriate dosing.

2. Procedure

The procedure for testing tricyclic and other cyclic antidepressants involves several key steps, which are outlined as follows:

Step 1: Sample Collection - The first step in the procedure is the collection of biological samples. A blood sample is obtained through venipuncture, which is a standard method for drawing blood from a vein. Alternatively, a urine sample can be collected either by random voiding or through catheterization, depending on the clinical scenario and the patient's condition.
Step 2: Sample Preparation - Once the samples are collected, they are prepared for analysis. This may involve processes such as centrifugation for serum or plasma samples to separate the liquid portion from the cellular components, ensuring that the analysis focuses on the relevant substances.
Step 3: Analytical Testing - The prepared samples are then subjected to specific analytical testing methods. For tricyclic antidepressants, quantitative liquid chromatography-tandem mass spectrometry is employed to accurately measure the levels of these compounds in urine, serum, or plasma. For the tetracyclic antidepressant loxapine, high-performance liquid chromatography is utilized. Additionally, quantitative gas chromatography is used for testing maprotiline and mirtazapine, ensuring precise quantification of these medications.
Step 4: Result Interpretation - After the testing is completed, the results are interpreted by qualified laboratory personnel or healthcare providers. The levels of the antidepressants are compared against therapeutic ranges to determine if the patient is within the appropriate dosing parameters or if adjustments are necessary.

3. Post-Procedure

Post-procedure care following the collection of samples for CPT® Code 80335 is generally minimal, as the primary focus is on the analysis of the samples rather than on invasive procedures. However, it is important for healthcare providers to communicate the results of the test to the patient and discuss any necessary adjustments to their medication regimen based on the findings. Patients may be advised to continue monitoring their symptoms and report any side effects or concerns to their healthcare provider. Additionally, follow-up testing may be scheduled as needed to ensure ongoing efficacy and safety of the antidepressant therapy.

Short Descr	ANTIDEPRESSANT TRICYCLIC 1/2
Medium Descr	ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2
Long Descr	Antidepressants, tricyclic and other cyclicals; 1 or 2
Status Code	Not Valid for Medicare Purposes
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
APC Status Indicator	Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
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.