decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 11 (November)
Genetic counseling generally not covered
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Article Overview
This article addresses a common billing and coding question involving genetic counseling requested for a child by a parent acting on the child’s behalf. It explains the general coding context for counseling services, the diagnosis categories mentioned for family history and consulting on behalf of another person, and notes that coverage may be limited by many payers. The content is relevant to coders, billing staff, and clinicians who document or report counseling-related services.
Why This Topic Matters
Genetic counseling requests often raise questions about who the patient is, what diagnosis categories apply, and whether the service is likely to be covered. This article helps readers recognize the general documentation and coding framework surrounding these encounters.
What You Will Learn
- How genetic counseling encounters for a minor are framed from a coding perspective.
- Which general diagnosis categories are referenced for a family-history-based counseling encounter.
- What broad CPT coding options are mentioned for genetic counseling and preventive counseling services.
- Why payer coverage may affect whether the service is billed or paid out of pocket.
Who Should Read This
- Medical coders
- Billing staff
- Obstetric and gynecology practices
- Genetic counselors
- Clinicians documenting counseling services
Codes Discussed
Code Ranges Discussed
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