Cracking the Code
Genetic and Genetic Counseling Services
What is genetic counseling? Per the NIH, a genetic counseling session “aims to increase the family’s understanding of a genetic disease, the risks and benefits of genetic testing and disease management, and available options. It is also a means to identify with the individual and family the psychosocial tools required to adjust to potential outcomes.” CPT code 96040 describes the services provided by a genetic counselor to see the genetic risk of hereditary diseases. It is important to note that this is a time-based code and is reported for 30 minutes of face-to-face time with the patient and family. As this is a time-based service, the provider must document the time spent in the encounter to report the correct number of units. The counselor typically obtains an extensive family history, and the service includes a review of medical data. Parents who have an impaired child often desire to determine any inherent risks for other offspring and may arrange genetic counseling. It may be determined that laboratory studies may be appropriate such as analysis of chromosomes, metabolic, and blood factor disorders.