Pathology/Lab Coding Alert

Question: As a molecular pathology lab, can we provide a service for genetic counseling? If so, how should we code the procedure?

Codify Subscriber

Answer: If you have a genetic counselor on staff, you can bill the service using 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family). This code is reserved for a trained nonphysician genetic counselor who analyzes a patient’s family risk factors for genetic conditions, analyzes available medical information, and counsels the patient and family.

CPT^® provides the following instruction for other cases of genetic counseling involving a physician, or other situations:

• For genetic counseling and education provided to an individual by a physician or other qualified health care professional who may report evaluation and management services, see the appropriate Evaluation and Management codes
• For genetic counseling and education to a group by a physician or other qualified health care professional, use 99078
• For education regarding genetic risks by a nonphysician to a group, see 98961, 98962
• For genetic counseling and/or risk factor reduction intervention provided to patient(s) without symptoms or established disease, by a physician or other qualified health care professional who may report evaluation and management services, see 99401-99412.