How Do I Code Genetic Counseling By A Physician

Limit 96040 to Trained Counselor Question: May we report 96040 if our physician is performing genetic counseling? Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) [...] Related articles:

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Limit 96040 to Trained Counselor

Question: May we report 96040 if our physician is performing genetic counseling?

Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) Don’t use 96040 for genetic counseling by a physician or nonphysician who is not a genetic counselor.

Although nothing precludes a physician from also being a genetic counselor, CPT states that if a physician provides genetic counseling to an individual, choose the appropriate E/M code. If the physician counsels a patient without symptoms or an established disease, CPT points you instead to 99401-99402 (Preventive medicine counseling …).

Before reporting 96040, you also should watch for services such as “obtaining a structured family genetic history, pedigree construction, analysis for genetic risk assessment, and counseling of the patient and family,” CPT states. The counselor may provide the services during one or more sessions and may review medical data and family information, conduct face-to-face interviews, and provide counseling. Report 1 unit for each 30 minutes of documented service.

If the patient receiving genetic counseling lacks symptoms, you should consider a V code. There are specific V codes for patients who have been tested and have a genetic probability:

• V84.01 — Genetic susceptibility to malignant neoplasm of breast

• V84.02 — Genetic susceptibility to malignant neoplasm of ovary

• V84.03 — Genetic susceptibility to malignant neoplasm of prostate

• V84.04 — Genetic susceptibility to malignant neoplasm of endometrium

• V84.09 — Genetic susceptibility to other malignant neoplasm.

AUDIO: 2010 Oncology Coding & Reimbursement Update.