LauraNewYork
Networker
My cancer center has started offering genetic testing for cancer. I need help making sure that the correct diagnosis codes are used when samples are sent for cancer gene testing. Specifically I am looking for help on Z84.81 family history of carrier of genetic disease versus Z80.- family history of primary malignant neoplasm and Z14.8 Genetic carrier of other disease versus Z15.0- Genetic susceptibility to malignant neoplasm. Two examples are:
Example Case 1
2 daughters in good health, come in for GC (individually) wanting to be gene tested for a specific gene mutation found in their mother.
Their mother had gene testing done because of her family history of multiple different cancers. This mother has no health problems related to cancer. Her gene test was positive for a deleterious gene mutation associated with cancer (APC gene).
I struggled finding codes for the daughters and ended up with family history of malignant neoplasm of digestive organs - Z80.0. However, per the NP they could only get insurance coverage using family history of carrier of genetic disease. - Z84.81. I think the Z84.81 is an inaccurate code and we are misleading the insurance company.
Example Case 2
Patient with DCIS at young age has gene testing. It comes back positive for BRIP1 mutation. The NPs want her coded as Z14.8 Genetic carrier of other disease. I think she should be coded as Z15.02 Genetic susceptibility of malignant neoplasm of ovary or the more general genetic susceptibility of malignancy.
Which is the correct code to use? Could someone with experience in cancer gene testing help answer my question?
Example Case 1
2 daughters in good health, come in for GC (individually) wanting to be gene tested for a specific gene mutation found in their mother.
Their mother had gene testing done because of her family history of multiple different cancers. This mother has no health problems related to cancer. Her gene test was positive for a deleterious gene mutation associated with cancer (APC gene).
I struggled finding codes for the daughters and ended up with family history of malignant neoplasm of digestive organs - Z80.0. However, per the NP they could only get insurance coverage using family history of carrier of genetic disease. - Z84.81. I think the Z84.81 is an inaccurate code and we are misleading the insurance company.
Example Case 2
Patient with DCIS at young age has gene testing. It comes back positive for BRIP1 mutation. The NPs want her coded as Z14.8 Genetic carrier of other disease. I think she should be coded as Z15.02 Genetic susceptibility of malignant neoplasm of ovary or the more general genetic susceptibility of malignancy.
Which is the correct code to use? Could someone with experience in cancer gene testing help answer my question?
diagnosis codes, diagnosis coding