CPT® Code 80337

Official Description

Antidepressants, tricyclic and other cyclicals; 6 or more

Common Language Description

A laboratory test identified by CPT® Code 80337 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 concentrations of 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 bedwetting in children. Examples of tricyclic antidepressants include clomipramine (Anafranil), amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Pamelor), doxepin (Sinequan), and trimipramine (Surmontil). Tetracyclic antidepressants, which are also included in this testing, consist of amoxapine (Asendin), loxapine (Loxapac, Loxitan), mirtazapine (Remeron, Avinza), and maprotiline (Ludiomil). The testing process involves obtaining a blood sample through a venipuncture, which is a separately reportable procedure, or a urine sample via random void or catheterization. The analysis of urine, serum, or plasma for TCAs is conducted using quantitative liquid chromatography-tandem mass spectrometry, while the TeCA loxapine is assessed using high-performance liquid chromatography. Additionally, amoxapine is tested using quantitative high-performance liquid chromatography, and maprotiline is evaluated through quantitative gas chromatography. Mirtazapine levels are determined using quantitative gas chromatography or gas chromatography-mass spectrometry. This code is specifically designated for cases where six or more cyclic antidepressants are being evaluated, distinguishing it from codes 80335 and 80336, which are used for testing one to two and three to five compounds, respectively.

1. Indications

The laboratory test associated with CPT® Code 80337 is indicated for the measurement of tricyclic and other cyclic antidepressants in patients who may be undergoing treatment for various psychiatric and medical conditions. The specific indications for this testing include:

Depression: Patients diagnosed with major depressive disorder or other depressive disorders may require monitoring of antidepressant levels to ensure therapeutic efficacy and safety.
Anxiety Disorders: Individuals suffering from anxiety disorders may be prescribed tricyclic antidepressants to help manage their symptoms, necessitating regular testing to adjust dosages appropriately.
Fibromyalgia: Patients with fibromyalgia may be treated with TCAs to alleviate pain and improve sleep quality, making it important to monitor drug levels.
Chronic Pain: Chronic pain management may involve the use of tricyclic antidepressants, and testing can help ensure that patients are receiving the correct dosage.
Bedwetting: In pediatric cases, tricyclic antidepressants may be prescribed for nocturnal enuresis (bedwetting), requiring monitoring of medication levels for effective treatment.

2. Procedure

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

Step 1: A blood sample is obtained from the patient through a venipuncture, which is a procedure where a needle is inserted into a vein to collect blood. This step is crucial as it allows for the analysis of serum or plasma for specific antidepressant levels.
Step 2: Alternatively, a urine sample may be collected either through random voiding or catheterization. This method provides another biological sample for testing the presence of antidepressants.
Step 3: The collected urine, serum, or plasma samples are then subjected to various testing methodologies. For tricyclic antidepressants, quantitative liquid chromatography-tandem mass spectrometry is employed to accurately measure drug levels.
Step 4: For the tetracyclic antidepressant loxapine, high-performance liquid chromatography is utilized to determine its concentration in the serum or plasma samples.
Step 5: Amoxapine levels are assessed using quantitative high-performance liquid chromatography, while maprotiline is tested through quantitative gas chromatography.
Step 6: Finally, mirtazapine is evaluated using either quantitative gas chromatography or gas chromatography-mass spectrometry, ensuring comprehensive testing of the relevant antidepressants.

3. Post-Procedure

After the procedure, patients may be advised to follow specific post-testing care instructions, although no explicit post-procedure care details are provided in the CPT® data. Generally, patients should be informed about the potential for minor discomfort at the venipuncture site and advised to hydrate adequately if urine samples were collected. The results of the tests will typically be reviewed by the prescribing physician to determine if any adjustments to medication dosages are necessary based on the measured levels of the antidepressants. Continuous monitoring may be recommended to ensure optimal therapeutic outcomes and to mitigate any potential side effects associated with the medications.

Short Descr	TRICYCLIC & CYCLICALS 6/MORE
Medium Descr	ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE
Long Descr	Antidepressants, tricyclic and other cyclicals; 6 or more
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.