Gastroenterology Coding Alert

Question: A patient came in our office for a Buccal Colaris genetic test based on family hx of colon cancer. How do we code this scenario? Do we use a CPT^® code for preventive care and if so which CPT^® code. What diagnosis code do we use [V16.0] alone or do we use V82.71 also?

Missouri Subscriber

Answer: Billing for the test depends on the actual service that your physician performed. If your physician just examined the patient at the clinic and simply performed a buccal rinse/swab then you should just report the E/M visit code:

• 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:…) for new patients, and
• 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:…), for established patients.

You cannot bill a pathology code unless your physician is involved in performing that procedure.

The Colaris genetic test is usually administered to target increased surveillance and other interventions specifically for individuals with familial adenomatous polyposis (FAP), Lynch Syndrome (formerly known as hereditary nonpolyposis colorectal cancer or HNPCC), and MYH-associated polyposis. The physician can obtain sample for the test in one of two ways: either through drawing blood, or through a buccal (oral) rinse. The sample is usually sent to a genetic testing laboratory to perform DNA sequencing analysis of MLH1, MSH2, and MSH6 genes. Sometimes, testing of PMS2 gene is also done.

Although the V codes (V16.0 and V82.71) have been replaced by Z80.0 (Family history of malignant neoplasm of digestive organs) and Z13.71 (Encounter for nonprocreative screening for genetic disease carrier status), please check your LCD for acceptable diagnosis. Z13.71 is not an accepted code for this test according to Blue Cross Blue Shield Association. Some acceptable codes may be C18.0 - C18.9 (Malignant neoplasm of colon), Z83.71 (Family history of colonic polyps).

If your physician is actually performing the genetic testing by himself in the lab, then based on the specific genes being tested, you can bill the following codes:

• MLH1gene analysis -- 81288
• MLH1 -- 81292, 81293, 81294
• MSH2 -- 81295, 81296, 81297
• MSH6 -- 81298, 81299, 81300
• PMS2 -- 81317, 81318, 81319

The code is to be chosen based on full sequence analysis, known family variant or duplication/deletion variants (the specifics for each code is available at code descriptors).