New Clinical Guidelines Released for OB-GYN Visits
New clinical guidelines jointly released by American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncologists (SGO) recommend all obstetrician/gynecologists (OB/GYNs) evaluate a patient’s risk for hereditary breast and ovarian cancer as a routine part of their practice.
A woman at high risk for breast or ovarian cancer, initially determined with a family history evaluation, should be referred to a clinician with expertise in genetics for further assessment, according to a new Practice Bulletin authored by the two organizations.
Women with a BRCA1 or BRCA2 mutation have a 65-74 percent chance of developing breast cancer in their lifetime, according to the Practice Bulletin. Lifetime risk of ovarian cancer is 39-46 percent in women with a BRCA1 mutation and 12-20 percent in women with a BRCA2 mutation.
Tumor suppression genes BRCA1 and BRCA2 encode proteins that function in the DNA repair process.
The Practice Bulletin also provides information on how to counsel patients with hereditary risk in cancer prevention and strategies for reducing risk.
For example, a woman can reduce her risk of breast cancer by up to 95 percent with a bilateral mastectomy. Less invasive strategies recommended to reduce breast cancer risk in women with a BRCA mutation include semiannual clinical breast examinations; an annual mammogram and annual breast magnetic resonance imaging screening beginning at age 25 or sooner, based on the earliest age onset in the family; and chemoprevention therapy with tamoxifen.
ACOG recommends periodic ovarian cancer screening with CA 125 and transvaginal ultrasonography beginning between the ages of 30 and 35 years or 5-10 years earlier than the earliest age of first family member ovarian cancer diagnosis for women with a BRCA mutation. Salpingo-oophorectomy surgery (removal of the ovaries and fallopian tubes) should also be offered by age 40 to a woman with a BRCA mutation to reduce her risk for ovarian cancer by up to 90 percent.
Medical genetics and genetic counseling services provided by trained genetic counselors should be reported with CPT® 96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family. CPT® 2009 refers you to Evaluation and Management (E/M) codes 99401-99412 for genetic counseling and education and/or risk factor reduction intervention provided by a physician to patient(s) without symptoms or established disease.
Genetic testing code modifiers 0A-BRCA1 hereditary breast/ovarian cancer and 0B-BRCA2 hereditary breast cancer should be used in conjunction with CPT® and HCPCS Level II service codes to provide diagnostic specificity, according to CPT® 2009.
Practice Bulletin No. 103 “Hereditary Breast and Ovarian Cancer Syndrome” is published in the April 2009 edition of Obstetrics & Gynecology.
For more information, read the full March 20 ACOG press release on which this report was based.