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.

Evaluation and Management – CEMC

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.

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5 Responses to “New Clinical Guidelines Released for OB-GYN Visits”

  1. Debbie says:

    This is great, that the clinicians are getting these needs in writing. Now we need to figuire out how to get insurance companies to pay for this preventative care. The CA-125 is $150.00 test. Insurance carriers do not cover this expense.

  2. Joyce McKay says:

    We just had a patient come in and request this test. The test was over $3,000.00 and her insurance would not cover it.

  3. karyl Bailey says:

    Remember to tell the patient the genetic counseling is free. (at least my counseling was). But I declined the testing for the full work up as the cost was out of my budget. My mother’s oncologist office also stated that the tests they have sent in for detection of the the gene’s marker were not covered for several of their patients. And Medicare will not pay for unnecessary tests that identify something she already has.

  4. Sandy Poyer says:

    Medicare will cover the test if the criteria is met, such as family history, age when the cancer was diagnosed. Other insurance companies take all of this into consideration also. I work for a breast surgeon and we order these tests daily on patients that have family history of breast and ovarian cancer. The lab also works to get authorizations for the genetic testing.
    If a close family member is positive, then other family members can be tested for free, as long as they submit the mutation that was identified.

  5. Barbara Haworth says:

    Having worked for an oncologic surgeon, who specialized in breast cancer, it was extremely difficult to obtain pre-authorization from medical insurance companies for the elective mastectomy once the BRCA test results were positive. It took months to obtain surgical authorization. This is a positive step in the right direction.

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