Genetic Testing
events and highest hospitalization rate . 2
The utility of the test expands well beyond warfarin and blood thinners . A landmark study in the New England Journal of Medicine showed that between 40 % to 75 % of drug therapy is less effective than expected . 1 Knowing how your patient is likely to respond to drug therapy – or why they might be responding poorly to a current regimen – can help with drug and drug class selection . It is noteworthy that so-called polypharmacy patients ( those on multiple drugs ) are at the greatest risk for adverse drug reactions , as the chance that one or more of the drugs will not be metabolized correctly increases with each drug prescribed .
Example Test
As an example of the broad applicability of this type of testing , we highlight the Extended DME Panel from Iverson Genetics ( Bothell , Wash .).
Iverson ’ s “ DME Panel ” tests for variations of
7 enzymes :
• CYP2C9 variations that affect response to warfarin , NSAIDs , fluvastatin , rosuvastatin , and others
• CYP2C19 variations affect response to clopidogrel , tricyclics , anticonvulsants , and others
• CYP2D6 variations that affect codeine response , antiarrhythmics , beta blockers , SSRIs and others
• CYP3A4 variant affects the response to atorvastatin , simvastatin and lovastatin , psychotropics , and others
• CYP1A2 , which can affect response to acetaminophen and Haldol , and others
• VKORC1 affects a patient ' s sensitivity to warfarin . COMT metabolizes catecholamine drugs such as dopamine , methyldopa and levodopa
Samples are collected via a buccal swab or blood draw and shipped to the laboratory ; test results and the report are returned within 24 hours of receipt .
Billing and Economics
For the Iverson test panel and certain other suppliers ’ panels , Medicare coverage extends to all CMS carriers in all localities . As noted earlier , many private insurers also cover the test .
Laboratories like Iverson bill insurers directly ; there is no cost to the practice for the test or test results , and no patient copays to collect . There is , of course , a “ soft cost ” – the time required for sample collection , analyzing the results and making subsequent treatment decisions , as warranted .
There are revenue components for physicians and their practices :
• Interpretation via CPT Code G0452-26 , Molecular pathology interpretation . The Medicare reimbursement ranges from $ 16.30 to $ 25.00 with a national median of $ 18.71 .
• Elevated E / M coding . Patients with abnormal variants will need medications reviewed , drug selection strategies assessed , and counseling on the life-long impact of these results
Summary
This diagnostic lab testing provides clinically useful information for patients on or about to be prescribed drugs that are metabolized by this system – about half the commonly prescribed drugs . Sample collection , shipping and the report are all straightforward . Medicare ’ s coverage of the test broadens it ’ s utility to all prescribers . And , while the clinical benefit of the test provides a compelling rationale for incorporating the test into your prescribing protocols , there also are modest but meaningful revenue opportunities for the physician and practices associated with the test .
For more information , search for # 7922 at physiciansofficeresource . com .
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