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Dx coding for genetic testing

smors1

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We are coding for genetic tests for pregnant women. If we get a requisition that lists History of Downs Syndrome/Father can we code a family history code such as Z84.81 or can we ONLY code for the mother? If we use the Z84.81 have we then "given" the mother this condition?

If consensus is that we cannot add a family history code, can we code a suspected chromosomal anomaly code such as O35.1 and is approval by the provider required?

Thank you in advance for your help.
 
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Dx code for genetic testing

If your performing testing on the father you would use Z31.440, if its for the mother can use O35.2XX0 - Maternal care for (suspected) hereditary disease in fetus hope this helps.
 

thomas7331

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Per ICD-10 guidelines, pregnancy cases require a code from the Chapter 15 category in the range O00-O09A, unless the provider has specifically documented that the pregnant state is incidental and not related to the services. Based on that, I think that using a history code in this situation would not be appropriate and the O35.1- codes sound like the most accurate code for why this test is being conducted based on the information you've given. I don't think that the provider's approval is required, however, since this is ultimately your practice's claims that could be at risk, not theirs. But if there is any question, it would not hurt to at least confirm with the provider that what you are billing aligns with the actual reason for the test as documented in the patient's record in case it ever came to be audited.
 
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