Oncology & Hematology Coding Alert

Question: Can we submit code 96040 for genetic counseling? Is it correct to submit E/M codes for genetic counseling services?

New York Subscriber

Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face 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, you should 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. You report one unit for each 30 minutes of documented service.