• 1.  Genetic Counseling Billing

    Posted 05-24-2022 10:39
    Hi all,

    Currently our genetic counselors bill independently (96040) when seeing patients.  We (physician) also see the vast majority of these patients on the same day of service to review ultrasound as well as any questions that arise from GC visit.  Sometimes we are addressing a separate maternal or fetal issue that requires an E/M visit, but for the majority of these discussions are not billing an E/M code, just the appropriate ultrasound procedure code.  Would it be more appropriate to bill these visits as E/M codes under the physician with time based billing or should we continue with our current model?

    Thanks for your thoughts!
    Jim Edwards

    James Edwards

  • 2.  RE: Genetic Counseling Billing

    Posted 05-29-2022 10:22

    Hi Jim
    In general, anything outside of providing ROUTINE NORMAL ultrasound results is a separately billable E/M service
    so as you said a maternal/fetal issue that is separate from the normal ultrasound - i.e. giving abnormal u/s results, discussing GHTN for example or management of some other MFM condition would be a separate E/M visit.  you typically have to add modifiers to your codes - please see coding question Q&A where we discuss this or in coding manual - so that the payers understand that the E/M is a separate distinct service from your ultrasound that day in the office and separate from other services performed that day.  whether you choose to bill the MFM counseling/discussion part as time or MDM would be up to your office, both are acceptable as long as your documentation supports code selection. 

    I think I understood your question, but also want to clarify if you are trying to get more into this scenario: 
    1) GC sees patient for a genetic indications - lets say family history of cystic fibrosis, spends 30 minutes bill 96040 - under their NPI - as a separately credentialed provider billing independently, provides own documentation. 
    2) patient has ultrasounds (lets say anatomy to make it easy) - 76811 is billed
    3) MFM now sees the patient givens normal results of the anatomy scan, but then also talks about their history of some other medical disease (lets say CHTN).  great - that's easy, that's the answer I gave you above, you can bill that E/M visit.  however the MFM also discusses the family history of CF - which has already been discussed in the GC visit earlier that day?  you are trying to figure out if the MFM can also bill for that time/MDM of discussed CF? or how to add up that time? 

    this gets more complex - and I want you to get an accurate answer from our coding team
    if this is really your question (not the first part I answered) - then please send it to us officially on the coding committee website. 
    the coders/coding committee does not formally oversee this communities website. i try to answer questions as best I can if they are quick, but if you want the official SMFM coding response - send it to us here:
    that way you will get a response you can share with your division/coders

    Vanita Jain, MD
    Chair, SMFM Coding Committee