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Thread: Billing E/M for genetic testing counseling HNPCC

  1. #1

    Question Billing E/M for genetic testing counseling HNPCC

    AAPC: Back to School
    Patient came in stating reason for visit "consultation reagrding genetic testing" she has a strong family history of colorectal cancer. The MD is scheduling a screening colonoscopy which under normal cicumstances not allow us to bill an E/M per AGA guidance. However, he did spend 20 minutes counseling her on having genetic testing for lynch syndrome (HNPCC). Would this discussion be billable under 99401 if documented accurately? I am thiking no since the code specifies risk factor reduction which you cannot do for genetics. Help, having self doubts.....

    If no, could we have the pateint sign an ABN stating time with teh physician to discuss this is a non-covered service and bill her directly? I hate to give 20 min of MD time away when the pateint just wants to pick his brain.

    Anna Barnes, CPC, CEMC

  2. #2
    Join Date
    Apr 2007


    I usually bill this as E/M based on time with dx codes v16.0, v12.72, v18.51. There are other codes for family history of gyn malignancy as well.

    The purpose of these visits for me is not just colonoscopy discussion but screening/risk reduction for other cancers as well.

  3. #3


    Thank you for replying. The documentation is specifically focused on genetic testsing counseling for HNPCC. If you look at the last parenthicital note under CPT code 96040 it states,

    "For genetic counseling and/or risk factor reduction intevention provided by a physician to patient(s) without symptoms or established disease, see 99401 -99412"

    Codes 99401 -99412 are based on counseling time. I spoke with a coder with the American College of Surgeons who agreed with 99401 based on the documentation.

    If our physcian did discuss other risk factors, signs, symptoms, or diseases along with the genetic testing then I would bill using time as a factor using 99201-99205, 99212-99215, or 99241-99215 if over 50 % of the total time was based on counseling.

    Anna Barnes, CPC, CEMC

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