Pathology/Lab Coding Alert

Question: Our lab is a full-service genetic testing lab, and we have certified genetic counselors on staff who meet with patients before and after genetic testing. How should we code the full range of services we provide?

Texas Subscriber

Answer: First, you should code the specific genetic test that you perform, such as 81443 (Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)).

If you have a member of staff who is a Certified Genetic Counselor (CGC), credentialed by the American Board of Genetic Counselors (ABMG) (www.abgc.net), you can document their services with 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family).

Time: Consistent with CPT^® general instructions for time-based coding, which tells you that “a unit of time is attained when the mid-point is passed,” the guidelines for 96040 instruct that you can only report the code once the counseling has passed the 15-minute mark. You cannot report counseling lasting 15 minutes or less.

That means you’ll report one unit of 96040 for a counseling session lasting 16-30 minutes, an additional unit for a session lasting from 46-60 minutes, and so on.