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CGX Personal History

Apurva Posted Wed 22nd of April, 2020 08:30:34 AM
Need clarification on the cancers below are deemed “qualifying” and medically necessary for running CGX test. Please provide back any data that you find in regards to reimbursement for these cancers, assuming that it is a personal history. o Breast/Ovarian/Cervical o Prostate/Testicular o Pancreatic o Uterine o Melanoma o Stomach, Kidney, Liver, Colon, Rectal, Bladder o Throat o Brain o Thyroid o Adrenal Cortical
SuperCoder Answered Fri 24th of April, 2020 02:39:51 AM

Hi Apurva,

Thank you for your question.

Seeing the above document, we would like to have more clarification as what exactly you are looking for.

Is it regarding the ICD-10 codes or the CPT codes that is required? Does patient already have had personal history of any cancer mentioned below. Is it the lab test that is needed? kindly provide us with more details to help you with exact codes or guidelines.

In the mean time as per my understanding with the limited documentation please see the below codes that may help to some extent.

Z15.0 (Genetic susceptibility to malignant neoplasm),

Z15.01 -- Genetic susceptibility to malignant neoplasm of breast Z15.02 -- … ovary> >Z15.03 -- … prostate Z15.04 -- … endometrium Z15.09 -- … to other malignant neoplasm Z15.81 -- Genetic susceptibility to multiple endocrine neoplasia (MEN) Z15.89 -- … to other disease.

Use additional> code, if applicable, for any personal history of malignant neoplasm ( Z85>.---) or if it only the personal history and no genetic involvement then go for this series only.

Other scenario :

If your physician is actually performing the genetic testing by himself in the lab, then based on the specific genes being tested, you can code the following:


MLH1 --> 81292, 81293, 81294


MSH2 --> 81295, 81296, 81297


MSH6 --> 81298, 81299, 81300


PMS2 --> 81317, 81318, 81319

The code is to be chosen based on full sequence analysis, known family variant or duplication/deletion variants (the specifics for each code is available at code descriptors).

Feel free to ask for further query. And make further clarification to make us understand what actually is required.

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