Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed a Buccal Colaris genetic test for a patient with a prior family history of colon cancer. As this is the first time that our gastroenterologist used this test, I am not sure how to report the test he performed. Also, please tell me what diagnosis codes I should use to substantiate the medical necessity of the test that our gastroenterologist performed?

North Carolina Subscriber

Answer: Buccal Colaris genetic test is a DNA sequencing analysis for MLH1, MSH2 and MSH6 genes and is sometimes used to test PSM2 gene also. For this test, a blood sample is drawn or an oral swab sample is attained which is then subject to the test for these specific genes.

The way in which you will report the test will depend on what exactly was done by your gastroenterologist. If he was only involved in examining the patient and obtaining the sample, then you cannot bill for the pathology codes associated with the Buccal Colaris genetic test. Instead, you will only have to bill the appropriate E/M codes (such as 99201, Office or other outpatient visit for the evaluation and management of a new patient...-99215, Office or other outpatient visit for the evaluation and management of an established patient...).

For supporting the medical necessity of the Buccal Colaris genetic test, you will have to provide the diagnosis codes i.e. V82.71 (Screening for genetic disease carrier status) and V16.0 (Family history of malignant neoplasm of gastrointestinal tract).

In the rare case that your gastroenterologist is also performing the pathology aspect of the test, then you can code the test based on the specific genes that are being tested for:

• MLH1 -- 81292-81294 (MLH1 [mutL homolog 1, colon cancer, nonpolyposis type2] [e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome] gene analysis...)
• MSH2 -- 81295-81297 (MSH2 [mutS homolog 2, colon cancer, nonpolyposis type1] [e.g., hereditary non- polyposis colorectal cancer, Lynch syndrome] gene analysis...)
• MSH6 -- 81298-81300 (MSH6 [mutS homolog 6 [E. coli]] [e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome] gene analysis...)
• PMS2 -- 81317-81319 (PMS2 [postmeiotic segregation increased 2 [S. cerevisiae]] [e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome] gene analysis...)

The code is to be chosen based on full sequence analysis, known family variant or duplication/deletion variants.

Otherwise, the lab facility that is running the test will report the pathology codes for the procedure and your gastroenterologist will only have to report the E/M codes and the diagnosis codes.