opinions sought - billing for screening prompted by family history

I have a question about billing for genetic cancer screening prompted by responses to a family history questionnaire. I've gotten several different answers to this question, and am trying to determine 'best practices' for this situation.

If the patient is visiting for a preventive care/well woman exam, and the family history she provides indicates that she should also be counseled about genetic screening for cancer and a sample collected (e.g., BRCA1/2 genetic testing), is the proper approach to use an E&M code (in addition to the preventive) for this unplanned counseling (with a family history diagnostic code for that portion)? Are there other alternatives that might be more appropriate (besides having the patient return -- which she might avoid doing if not urged to here about her risk on the spot)?

Certainly one issue is the unexpected patient responsibility if a 992xx is billed on the same day as a free well visit. But the patient could presumably be advised about that. Any other thoughts on this subject? How would you approach it? Thanks.

re: opinions sought - billing for screening prompted by family history

I'm not sure this wouldn't be considered part of the preventive. I've never heard of it being separately billed.

Others?

re: opinions sought - billing for screening prompted by family history

I agree

re: opinions sought - billing for screening prompted by family history

Thank you both for your responses!!

Follow up question:

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re: opinions sought - billing for screening prompted by family history

Oops, sorry for the false start on my follow up question. Here it is:

- if the patient had contacted the practice because she had learned a close relative had been diagnosed with cancer and wanted to find out if she was a candidate for genetic testing, would that visit we coded as E&M (with family history ICD code) or counseling?

- after testing is completed, the patient will return to hear the results -- if negative, she needs to be counseled about remaining cancer risk and how to reduce it; if positive, course of treatment (prophylactic surgery or chemoprevention and/or augmented surveillance) must be determined. Would those visits be billed as 99401-4 (negative result, risk reduction counseling) and E&M (positive result, treatment/risk reduction)? Or some other way?

Have heard a couple of different options on both of these questions and am wondering if there may be some differences across payers.

Thanks for any feedback!

re: opinions sought - billing for screening prompted by family history

If patient is asymptomatic, it is a preventive visit. ICD-9 codes for family history and counseling would be appropriate (V codes) there is a "worried well" (V) code.
Category V84.xx describes Genetic susceptibility to disease. It depends on documentation.
Risk factor counseling is code 9940x series.

re: opinions sought - billing for screening prompted by family history

The preventive medicine individual counseling codes cannot be billed on same date of service as a preventive medicine service (993xx series)