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Genetic testing question

Joseph Posted Wed 16th of May, 2012 17:05:17 PM

We have a patient that came in our office for a Buccal Colaris genetic test based on family hx of colon cancer. My question is how do we code this? Do we use 99211 as a cpt code and then icd 9 code V82.81 for the genetic test and V16.0 for the family hx of colon cancer? Or do we use a cpt code for preventive care and if so which cpt code. This is our first patient for this test and I am not sure how to code this. Thanks for your help with this issue.

SuperCoder Answered Thu 17th of May, 2012 12:06:00 PM

Buccal Colaris genetic test can now be performed in two ways: by drawing blood, or by taking an oral swab. The sample is usually sent to a genetic testing laboratory to perform DNA sequencing analysis of MLH1, MSH2, and MSH6 genes. Sometimes, testing of PMS2 gene is also done.

The code depends on what is actually being performed by your physician. Is your physician checking the Pt. at his clinic and simply performs a buccal swab? If yes, then bill with E/M visit code (99201-99215). You cannot bill a pathology code unless your physician is invloved in performing that procedure.

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).

Joseph Posted Thu 17th of May, 2012 14:26:33 PM

Okay, so we use the 99211 code as the nurse took a swab on the patient. What icd 9 code do we use [V16.0] alone or do we use V82.81 also? We are a gastroenterologist office and the test was done with a swab with no doctor present and will be sent to a lab. I just need to know which icd 9 codes to use or if I need to use both. V82.81 is genetic screening for suspected carrier status. Thanks

SuperCoder Answered Fri 18th of May, 2012 09:22:37 AM

Code both Dx in the order of --> V82.71, V16.0

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