Oncology & Hematology Coding Alert

Question: We-re considering hiring a genetic counselor. What should I know about coding for this type of service?

New Mexico Subscriber Answer: CPT 2007 provides a new code for this service: 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family). But remember that just because you have a code that doesn't mean insurance will reimburse you for it.

This code also comes with a long list of guidelines in the CPT manual:

- Report this code for services provided by trained genetic counselors only.

- Look for services such as -obtaining a structured family genetic history, pedigree construction, analysis for genetic risk assessment, and counseling of the patient and family.- 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.

- Don't use this code for genetic counseling by a physician or nonphysician who is not a genetic counselor.

ICD-9 tip: Patients receiving genetic counseling will often lack symptoms, so you-ll likely need to report 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.