96160 for tyrer cuzick model screening

williafm

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Our manager wants our providers to bill cpt code 96160 when a patient completes the Tyrer Cuzick breast cancer risk assessment. Is this appropriate? I think it's part of the E & M but can't find any info on it.
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nichenson

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"You may bill this service if the instrument was administered and scored in a diagnostic setting in conjunction with an office visit. You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. For Medicare purposes, you also should not bill 96160 separately if furnished as a preventive service, because at that point it would describe a non-covered Medicare service."

There is nothing that explicitly states about this test. However, from their website, it defines it as a "tool utilized to inform women and help support the decision making process for genetic counseling and testing." Given this statement and its short form I would not recommend using it on any E/M that has counseling as part of its description such as preventative medicine. If it done during the course of a normal office visit, then I would say use it only if the test is placed in the medical record and there is adequate documentation from the doctor on both the results and discussion/counseling with the patient.
 
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