Wiki Please help! Can 99401 be billed for discussion of prenatal genetic test during antenatal care?

[jhbpine]

So my providers bill globally for prenatal care. But one of my providers has been trying to bill 99401 for discussing prenatal genetic tests with the patient. Is this billable? I know most payers consider discussing breastfeeding and pumping to support 99410. I can't find anything saying discussing prenatal tests like the NIPT and NT, CFDNA, serum and Maternity 21 to be covered with 99401. Does anyone know the answer?

 

[nielynco]

So my providers bill globally for prenatal care. But one of my providers has been trying to bill 99401 for discussing prenatal genetic tests with the patient. Is this billable? I know most payers consider discussing breastfeeding and pumping to support 99410. I can't find anything saying discussing prenatal tests like the NIPT and NT, CFDNA, serum and Maternity 21 to be covered with 99401. Does anyone know the answer?

Okay, nobody else seems to want to jump in here so her is my two cents worth. If the physician is simply telling the patient with no past history that certain tests are available, the answer would be no. If you are dealing with a patient who has a past history that requires a selection of certain recommended testing, then possibly. But I would not bill it as 99401 as this implies a preventive service which would not be the case with a history or current condition that could lead to genetic anomalies in the fetus. We now have code for genetic counseling which might apply: 96040 if your physician has documented the requirements for this code. But if you do not (requires 30 minutes of counseling), CPT has directed you to you a problem E/M code for this counseling.

 

[jhbpine]

Thanks, I checked with my boss too and she agreed that the global delivery charge would include this and 99401 would not be billable.