Question Need help assigning correct cancer codes for gene testing

LauraNewYork

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My cancer center has started offering genetic testing for cancer. I need help making sure that the correct diagnosis codes are used when samples are sent for cancer gene testing. Specifically I am looking for help on Z84.81 family history of carrier of genetic disease versus Z80.- family history of primary malignant neoplasm and Z14.8 Genetic carrier of other disease versus Z15.0- Genetic susceptibility to malignant neoplasm. Two examples are:

Example Case 1
2 daughters in good health, come in for GC (individually) wanting to be gene tested for a specific gene mutation found in their mother.

Their mother had gene testing done because of her family history of multiple different cancers. This mother has no health problems related to cancer. Her gene test was positive for a deleterious gene mutation associated with cancer (APC gene).

I struggled finding codes for the daughters and ended up with family history of malignant neoplasm of digestive organs - Z80.0. However, per the NP they could only get insurance coverage using family history of carrier of genetic disease. - Z84.81. I think the Z84.81 is an inaccurate code and we are misleading the insurance company.

Example Case 2
Patient with DCIS at young age has gene testing. It comes back positive for BRIP1 mutation. The NPs want her coded as Z14.8 Genetic carrier of other disease. I think she should be coded as Z15.02 Genetic susceptibility of malignant neoplasm of ovary or the more general genetic susceptibility of malignancy.

Which is the correct code to use? Could someone with experience in cancer gene testing help answer my question?
 

kpeterson15

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I have no experience with cancer coding, but with the information you gave, Z84.81 seems to be acceptable because their mother did test positive for a genetic mutation linked to cancer. I do not think that is misleading the insurance company. Now, if the mom did not test positive for the gene or if it was still unknown then I believe that would be misleading the insurance company because you would not know officially if the mother was a gene carrier or not.
 

kpeterson15

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As for your second question, it seems they want the first code, Z14.8, because this mutation can be linked to more than just ovarian cancer such as breast cancer and other cancers. So, their Z14.8 seems to cover a broad range of cancers versus just ovarian cancer.
 

csperoni

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Case 1: I agree with kpeterson. The mother (family) did test positive for a mutation. Therefore, the mother is the family member who is a carrier of genetic disease. Z84.81 is acceptable to me as well.

Case 2: My understanding of BRIP1 mutation is that it is currently only linked to ovarian cancer risk increase, and is not the same as BRCA1. I think Z15.02 is MOST accurate. Z14.8 is not wrong per se, but when there is a more specific code, you are instructed to use the more specific code. If BRIP1 also increases other cancer risk, I would also include secondary dx Z15.0- for the other increased risk. If BRIP1 also increases other (non malignant) disease risk without a more specific code, then secondary Z14.8 would be accurate.
 

LauraNewYork

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Thank you both so much!
Before I heard back from you, I did more digging and found in the ICD 10 code book, p. G28 the following information I'd like to pass on.
Z14 Genetic carrier - "The person does not have the disease and is not at risk of developing the disease" (emphasis mine).
Z15 Genetic susceptibility to disease - "Genetic susceptibility indicates that a person has a gene that increases the risk of that person developing the disease. (emphasis mine)"

If I'm reading these rules correctly, then:
Case 1 the mother has increased risk for cancer due to a mutation and therefore has "genetic susceptibility". The coding for the daughters is complicated. Z84.81 refers to carrier status which doesn't fit the rules, but there is no code for family history of genetic susceptibility. Would family history of cancer Z80.9 be acceptable?

Case 2 the individual with the BRIP1 mutation has an increased risk of ovarian malignancy and therefore has "genetic susceptibility to ovarian cancer". It appears there may be other cancers associated with this mutation, but they are not yet proven, so I think I'm going to leave her as Z15.02.

Any comments appreciated.
 

kpeterson15

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Z14 is a genetic carrier, but your Z84.81 code is saying the family history of genetic disease and seems to be referring to family carrier status not personal carrier status. I believe this would still be acceptable because it is referring to her family, not herself being the genetic carrier. This code is showing she has an increased risk because of a family history of the genetic gene. Since her mom is a genetic carrier, that would work in this case since her mom is family.
I was looking this code up on the internet and here is a list of synonyms it gave me. The reason I think it could still be an appropriate code is the bolded part below. Maybe even this list can give you another idea of which code you would like to use. :)

Approximate Synonyms
  • At risk for heritable disorder based on family history
  • Family history of brca gene mutation
  • Family history of brca gene mutation in first degree relative
  • Family history of brca1 gene mutation
  • Family history of brca2 gene mutation
  • Family history of breast cancer 1 gene mutation
  • Family history of breast cancer 2 gene mutation
  • Family history of breast cancer gene (brca) mutation
  • Family history of breast cancer gene (brca) mutation in first degree relative
  • Family history of gene mutation
  • Family history of gene mutation for lynch syndrome (hereditary nonpolyposis colon cancer, hnpcc)
  • Family history of gene mutation for lynch syndrome (inherited condition causes high risk of colon cancer)
  • Family history of genetic disease carrier
  • Family history of genetic disorder carrier
  • Family history of hereditary disease
  • Family history of hereditary disease carrier state
  • Family history of heritable disorder
  • Family history of heritable disorder with the patient or offspring at risk
  • Fhx of brca gene mutation in first degree relativ

 

kpeterson15

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I need help? I work for ambulatory surgery center and when coding z86.010 with 45378 it is getting denied by Medicare. Can I use g0105 as my cpt code?
Have they given you a reason why they are denying it?? Could it be your ICD-CM code that may need changing??
 

LauraNewYork

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Z14 is a genetic carrier, but your Z84.81 code is saying the family history of genetic disease and seems to be referring to family carrier status not personal carrier status. I believe this would still be acceptable because it is referring to her family, not herself being the genetic carrier. This code is showing she has an increased risk because of a family history of the genetic gene. Since her mom is a genetic carrier, that would work in this case since her mom is family.
I was looking this code up on the internet and here is a list of synonyms it gave me. The reason I think it could still be an appropriate code is the bolded part below. Maybe even this list can give you another idea of which code you would like to use. :)

Approximate Synonyms
  • At risk for heritable disorder based on family history
  • Family history of brca gene mutation
  • Family history of brca gene mutation in first degree relative
  • Family history of brca1 gene mutation
  • Family history of brca2 gene mutation
  • Family history of breast cancer 1 gene mutation
  • Family history of breast cancer 2 gene mutation
  • Family history of breast cancer gene (brca) mutation
  • Family history of breast cancer gene (brca) mutation in first degree relative
  • Family history of gene mutation
  • Family history of gene mutation for lynch syndrome (hereditary nonpolyposis colon cancer, hnpcc)
  • Family history of gene mutation for lynch syndrome (inherited condition causes high risk of colon cancer)
  • Family history of genetic disease carrier
  • Family history of genetic disorder carrier
  • Family history of hereditary disease
  • Family history of hereditary disease carrier state
  • Family history of heritable disorder
  • Family history of heritable disorder with the patient or offspring at risk
  • Fhx of brca gene mutation in first degree relativ

Thank you.
 

tabytha

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One of the chapters in CT is having a virtual meeting to discuss genetic testing if you are interested in participating. They don't charge but it may be helpful for you.

Torrington/Waterbury Connecticut (86006)​

VIRTUAL MEETING: Genetic Counseling​

Local Chapter Meeting

General Event Information
Start Date:5/20/2021
Start Time:6:00 PM
Finish Date:5/20/2021
Finish Time:8:00 PM
Presentation Length:2.00 hours
CEUs:2.00
Specialty CEUs:CPC-P, CPPM, COC, CPB, CPC
Event Location Information
Location:Virtual
34 Mano Lane
Bristol, Connecticut 06010
United States
Directions:Please join us at this URL: https://aapc.zoom.us/meeting/register/tJAlde-pqzsoGNDhgSiSIl-e0NPliEeClogi
Speaker Information
Speaker:Susan R. Capasso, MS,EdD, CGC and licensed in CT
 
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