Oncology & Hematology Coding Alert

Question: One of our patients presented with her husband — they are both survivors of cancers, with the wife’s being a rare type and the husband’s more common. They met with the oncologist for the wife’s follow-up visit, but then asked him to provide genetic counseling to discuss the risks of a baby potentially having the same cancers that they had. Can our oncologist report a genetic counseling code for this service?

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Answer: Your oncologist can provide genetic counseling, but it is best to have dedicated and trained personnel for genetic counseling. Your oncologist cannot use 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family) because this is reserved for genetic counselors. However, nothing precludes your physician from spending part of her E/M visit discussing his opinion of the potential complications or issues for this patient and her family having a child.

CPT’s notes state, “For genetic counseling and education provided to an individual by a physician or other qualified health care professional who may report evaluation and management services, see the appropriate evaluation and management codes.” Therefore, you should choose an appropriate code from the 99201-99215 series as supported by the visit note documentation.

If the oncologist’s discussion with the patient and her husband is lengthy, you may want to consider reporting the appropriate E/M code based on the time spent counseling. In that case, be sure that the oncologist’s documentation includes a description of what they discussed, notation of the total time of the visit, and the specific amount or percentage of that time spent counseling.