CPT Codes and ICD-9 Codes for Genetic Counseling Services & Related Services
Note: The following list of codes may apply to genetics clinics. Codes may change and be updated, please verify the applicability for individual patients.
ICD-9 coding classification system is used to describe diseases and operations, for physician reimbursement, hospital payments, quality review and benchmarking measurement
CPT® (Current Procedural Terminology) Codes, American Medical Association, descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and serves as an effective means for reliable nationwide communication among physicians, and other healthcare providers, patients, and third parties.
- ICD-9 Search, E-MDs (chromosome anomalies)
- ICD-9-CM,
eicd.com, Yaki Technologies,
searchable, free registration
-
International
Classification of Diseases (ICD), functioning & disability, ICD-9, National Center for Health Statistics,
Centers for Disease Control (CDC)
- ICD-9-CM
Alphabetic Index to Diseases,
Duke University Medical Center, congenital
anomalies, ICD-9 Codes
- ICD-9
codes relevant to Clinical Biochemical Genetics, Biochemical Genetics, University of California San Diego (UCSD), Society for Inherited Metabolic Disorders, (SIMD)
- ICD-9-CM
at eicd.com
- ICD-9
Codes for Family Practice:
2004-2005
- Incidence
Prevalence Database,
Timely Data Resources, Inc.
- Manual
on Reimbursement for Medical Genetics Services,
2001, American College
of Medical Genetics
- Physician
Referral Codes,
von Hippel Lindau Syndrome, RR Williams, Sutter Gould Medical Foundation,
2001
- PMICOnline.com, Practice Management Information Corporation
- ICD-9
Search , KU Medical Center
- CD-9-CM 2005 Special Reports, American Medical Association
Genetic
Counseling / Counseling and/or Risk Factor Reduction
CPT Codes
- Limited Consult (15-30 min) 99242
- Intermediate Consult 99243
- Comprehensive Consult, 60 minutes 99244
- Complex Consult 99245
- Counseling and/or Risk Reduction Intervention 99401-99429
Genetic counseling services include obtaining a structured family genetic history, pedigree construction, analysis for genetic risk assessment, counseling of the patient and family. One or more sessions may include a review of medical data and family information, face-to-face interviews, and counseling services. One time unit for every 30 minute of services provided face-to-face.
- Group Counseling 99411-99412, 99078 group genetic counseling (MD)
- Individual Counseling 99401-99404 (99215)
- 99401 - 99412 Genetic counseling an/or risk factor reduction intervention provided by a physician to patient(s) without symptoms or established disease
- Genetic Counselor codes (trained genetic counselor, not MD):
- Genetic counseling 99211-5
- Genetic Counselor 96150-5
- 96040 Genetic Counseling(30-minute units face-to-face with patient/family, review of medical data, interviews, counseling)
- 98961, 98962 education regarding genetic risks by nonphysician to a group
Office or Other Outpatient Medical Services - New Patient
99401 Preventative medicine counseling provided to an individual (~15 min) Office, other outpatient visit, new patient
99402 ~ 30 min Level 2
99403 ~45 min Level 3
99404 ~ 60 min Level 4
99205 Level 5
Office or other outpatient medical services - Established patient
99411 Preventative medicine counseling in a group setting (per participant) Office, other outpatient
99212 Level 2
99213 Level 3
99214 Level 4
99215 Level 5
99420 Administration and interpretation of health risk assessment
ICD-9 Codes
655.2 Family History, hereditary disorder possibly affecting fetus (pregnant)
655.3 Family history, hereditary disorder (pregnant)
655.5 Maternal drug use
V16 codes (screening codes) - office consult
V18.9 Genetic disease carrier Family member is a carrier of a genetic disease FAMILY HISTORY: new code (Oct 2004)
V19.5 Family history, congenital anomalies (hereditary disease)
V26.3 genetic counseling for procreative management (prenatal or pre-pregnancy) counseling
V26.3 (screening) unaffected
V26.31 Testing of female for genetic disease carrier status (CARRIER SCREENING: new code Oct 2004)
(V26.32 other genetic testing of female)
V26.33 Genetic Counseling and testing CARRIER SCREENING: new code (Oct 2004)
V26.34 Testing of male for genetic disease carrier status
V26.35 Encounter for testing of male partner of habitual aborter (i.e., male partner of women with multiple miscarriages)
(V26.39 other genetic testing of male)
V29.3 Observation of newborn for suspected genetic/metabolic condition
V61.49 Concern (about increased risk, cancer, other genetic condition)
V77.6 screening, CF
V77.7 Screening, other inborn errors of metabolism
V82.7 Genetic screening
V82.71 Screening for genetic disease carrier status (i.e. direct DNA testing BRCA)
V82.79 other genetic screening (i.e. MSI)
V82.8 special screening other conditions
V83 Genetic carrier status
V83.8 Other genetic carrier status
V83.89 Other genetic carrier status
V84 Genetic susceptibility to disease
V84.0 Genetic susceptibility to malignant neoplasm
V84.01 Genetic susceptibility to malignant neoplasm, breast
V84.02 Genetic susceptibility to malignant neoplasm, ovary
V84.03 Genetic susceptibility to malignant neoplasm, prostate
V84.04 Genetic susceptibility to malignant neoplasm, endometrium
V84.09 Genetic susceptibility to other malignant neoplasm
V84.8 Genetic susceptibility to other disease
Cancer / related codes
CPT Codes
- New Patients: 992414, 992422, 992430, 992448 and 992455
- Two hour pre-test visit 992455
ICD-9 Codes
153.2 Malignant neoplasm of colon, at the descending portion
153.9 Malignant neoplasm of colon, Primary Colon Cancer (or 153.8) (not polyps only)
154 Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.1 Malignant neoplasm of rectum
157 Malignant neoplasm of pancreas
157.9 Malignant neoplasm of pancreas, unspecified
172 Malignant melanoma of skin
172.9 Malignant Melanoma ?
173 Other malignant neoplasia of skin
173.3 Other malignant neoplasia of skin (skin of other and unspecified parts of face, i.e. Gorlin basal cell carcinoma)
173.5 Other malignant neoplasm of trunk (except scrotum)
173.9 Other malignant neoplasm of skin, unspecified site
174 Malignant neoplasm of female breast
174.8 Malignant neoplasm of female breast (NEC)
174.9 Breast Cancer Malignant neoplasm of female breast, unspecified (NOS)
175.0 Malignant neoplasm of male breast, nipple and areola
175.9 Malignant neoplasm of male breast, other or unspecified site
179.0 Uterine Cancer, Malignant neoplasm of uterus, site unspecified
180 Cervical cancer
182 Uterine cancer
183.0 Malignant Neoplasm, Ovary (currently affected)
183.3 Malignant neoplasm of broad ligament
185.0 Malignant Neoplasm, Prostate
186 Malignant neoplasm of testis
189.0 Renal Cell Carcinoma (kidney), Malignant neoplasm of kidney
191 Malignant neoplasm of brain
193 Malignant neoplasm of thyroid
194.0 Malignant neoplasm of adrenal gland
194.1 Malignant neoplasm of parathyroid gland
194.3 Malignancy of pituitary gland and craniopharyngeal duct
194.5 Malignant neoplasm of carotid body
199 Malignant neoplasm, without specific site
211.3 Polyposis Colon Adenomatous, or FAP (current dx of benign neoplasm of large intestine, familial polyposis)
236.2 Neoplasm of uncertain behavior: ovary (gonadoblastoma)
256.4 Polycystic ovarian disease
258.0 Multiple Endocrine Neoplasia
575.8 Gallbladder, other specific diagnosis
577.2 Pancreas (cyst, pseudocyst)
608.89 Scrotal mass
610.1 Fibrocystic Breast Disease
626.0 Amenorrhea
655.2 (Hereditary Disorder) women who are pregnant
758.3 Li Fraumeni (autosomal deletion syndrome)
759.6 Von Hippel Lindau (other hamartoses, cerebelloretinal hemangioblastomatosis, Peutz-Jeghers,
Sturge-Weber, retinocerebral angiomatosis)
789.07 Generalized abdominal pain
789.09 Abdominal pain, other specified site
759.6 hemangioblastoma
V10.3 History of breast cancer
V16.3 Family history of breast cancer
V76.10 Screening for breast cancer, unspecified
V84.01 Genetic susceptibility to malignant neoplasm, breast
V Codes
- V10.05 History of colon cancer
- V10.3 History of Breast Malignancy (personal hx)
- V10.43 History of Malignant neoplasm of ovary (ex: currently healthy but past dx of cancer)
- V10.46 History of prostate cancer
- V10.47 History of testicular cancer
- V10.52 History of kidney cancer
- V12.72 Personal Hx colonic polyps
- V16.0 Family History Malignant Neoplasm / Colon Cancer GI cancers
- V16.3 Family History Malignant Neoplasm / Breast Cancer, Female
- V16.4 Family history of genital cancer (malignant neoplasm, ovary, prostate, testis, other)
- V16.41 Family history of Ovarian Cancer
- V16.42 Family history of prostate cancer
- V16.49 Concern regarding family history .. . .personal history of, or family history of (about increased risk, cancer, other genetic condition) V16.49 Family history of genital cancer; other
- V16.5 Family hx, urinary organs ca
- V16.51 Family history of kidney cancer
- V16.59 Family hx other ca V16.59 Family history of urinary cancer (other)
- V16.6 Family hx leukemia V16.7 Family history of lymphatic/hematopoietic neoplasms
- V16.8 Family History of Ca ?
- V16.9 Unspecified malignant neoplasm ?
- V17.0 Family history certain chronic / disability disease (.4 psychological, .8 other musculoskeletal)
- V17.6 Family History of chronic respiratory disease - other
- V18.4 Family history mental retardation
- V26.3 Genetic Counseling
- V26.33 Genetic counseling
- V71.8 (Observe for suspected
condition)
- V76.1 ? Screening for breast cancer
- V76.4 ? Screening for cancer - other sites
- V76.46 ? Screening for ovarian cancer
- V76.49 ? Screening for cancer - other
- V76.51 ? Screening for cancer of colon
- V82.7 Genetic screening (p 636 ICD-9-cm 2006 errata)
- V82.71 Screening for genetic disease carrier status (p 636 ICD-9-cm 2006 errata)
- V82.79 Other genetic screening (p 636 ICD-9-cm 2006 errata)
- V84.01 Genetic susceptibility to malignant neoplasm, breast
- V84.03 Genetic susceptibility to malignant neoplasm, prostate
- V84.04 Genetic susceptibility to malignant neoplasm, endometrium
- V84.09 Genetic susceptibility to other malignant neoplasm
Chromosomal Conditions & Related dx
279.11 DiGeorge Syndrome
758 Chromosomal Anomalies (V19.5 with family history)
758.0 Trisomy 21 (Down Syndrome)
758.1 Trisomy 13 (Patau Syndrome) arhinencephaly
758.2 Trisomy 18 (Edward Syndrome) arrhinencephaly
758.3 Autosomal deletion syndrome
758.31 Cri-du-Chat
758.32 Velo-cardio-facial syndrome
758.33 Other microdeletions
758.39 Other autosomal deletions
758.4 Balanced autosomal translocation in normal individual
758.5 Other conditions due to autosomal anomalies
758.6 Turner Syndrome / Gonadal Dysgenesis
758.7 Klinefelter Syndrome
758.8 Other conditions due to chromosome anomalies
758.81 Other conditions due to sex chromosome anomaly
758.89 Other conditions due to chromosome anomalies
758.9 Conditions due to unspecified chromosome anomaly
759.81 Prader-Willi Syndrome
759.83 Fragile X syndrome
759.9 Congenital anomaly, unspecified
795.2 Nonspecific abnormality on chromosomal analysis
626.0 Amenorrhea
CHROMOSOMAL ANOMALIES: archaic terminology updated, and new codes October 1, 2004 758.3 Autosomal deletion syndromes
758.31 Cri-du-chat syndrome
758.32 Velocardiofacial syndrome
758.33 Other microdeletions (specifically list Smith-Magenis and Miller-Dieker)
758.39 Other autosomal deletions
Congenital
Anomalies (740-759)
740 Anencephalus and similar anomalies
741 Spina bifida
742 Other congenital anomalies of nervous system
742.1 Microcephaly
743 Congenital anomalies of eye (743.0 anopthalmos, 743.45 aniridia)
744 Congenital anomalies of ear, face, and neck
745 Bulbus cordis and cardiac septal closure anomalies
746 Other congenital anomalies of heart
747 Other congenital anomalies of circulatory system
748 Congenital anomalies of respiratory system
749 Cleft palate and cleft lip
750 Other congenital anomalies of upper alimentary tract
751 Other congenital anomalies of digestive system
752 Congenital anomalies of genital organs
753 Congenital anomalies of urinary system
754 Congenital musculoskeletal deformities
755 Other congenital anomalies of limbs
756 Other congenital musculoskeletal anomalies
757 Congenital anomalies of the integument
758 Chromosomal anomalies
759 Other and unspecified congenital anomalies
759.3 Situs inversus
759.7 Congenital Syndrome
759.81 Prader-Willi Syndrome / Angelman syndrome
759.82 Marfan Syndrome
759.83 Fragile-X Syndrome
759.89 Other (Congenital malformation syndromes affecting multiple systems, not elsewhere classified (i.e., Laurance-Moon-Biedl syndrome)
759.9 Congenital anomaly, unspecified
783.4 Developmental Delay
OTHER AND UNSPECIFIED CONGENITAL ANOMALIES: new indexing to current codes Oct. 1, 2004
759.89 Other specified congenital anomaly (Angelman, Cornelia de Lange)
759.89 CHARGE association/syndrome
757.33 Incontinentia pigmenti
759.89 Kabuki syndrome
759.89 Noonan syndrome
759.89 Oculo-auriculo-vertebral syndrome
756.0 Stickler syndrome
Other diagnoses
253.0 Sotos Syndrome
279.11 DiGeorge Syndrome
759.83 Fragile X syndrome
648.53 Tinnitus
759.7 Undiagnosed / unknown syndrome (multiple congenital anomalies, so described)
796.4 Dysmorphic syndrome (other nonspecific abnormal clinical findings)
279.43 Autoimmune disorder, not specified
Developmental Disorders
299.0 Autism, current infantile or childhood
299.8 Other specified pervasive developmental disorders (Asperger)
314.0 Attention deficit disorder
314.01 Attention deficit disorder, with hyperactivity
315.31 Developmental language disorder
315.32 Receptive language disorder (mixed)
315.4 Coordination disorder
315.5 Mixed developmental disorder
317 Mild mental retardation
318 Moderate mental retardation
318.1 Severe mental retardation
318.2 Profound mental retardation
319 Unspecified mental retardation
389.9 Deafness, Unspecified hearing loss
629.8 Female genital organs, other, unspecified
759.5 Tuberous sclerosis
759.89 Smith Lemli Opitz (cerebrohepatorenal syndrome)
759.81 Prader Willi
783.40 Delayed milestones (lack of expected normal physiologic development, unspecified)
Hematologic conditions
282.4 Alpha thalassemia (thalassemias)
282.4 Beta thalassemia (thalassemias)
282.2 G6PD deficiency (anemias, glutathione metabolism disorders)
286.0 Hemophilia A (Congenital factor VIII disorder)
286.1 Hemophilia B (congenital factor IX disorder)
282.1 Hereditary elliptocytosis
282.0 Hereditary spherocytosis
282.61 Sickle cell anemia (Hb SS) without crisis
282.62 Sickle cell anemia (Hb SS) with crisis
282.63 Sickle cell disease (Hb SC)
282.4 Sickle cell / thalassemia (thalassemias)
282.5 Sickle cell trait
282.7 Other hemoglobin
286.4 Von Willebrand disease
Metabolic conditions
273.4 Alpha-1 antitrypsin deficiency (other deficiencies of circulating enzymes)
277.0 Cystic fibrosis (without meconium ileus), with 277.01
271.1 Glactosemia
272.7 Gaucher (lipidoses)
275.0 Hemochromatosis (disorders of iron metabolism)
277.1 Disorders of porphyrin metabolism
277.5 Hunter syndrome (mucopolysaccharidosis)
277.5 Hurler (mucopolysaccharidosis)
277.6 Other deficiencies of circulating enzymes
330.0 Krabbe disease (leukodystrophy)
330.8 Leigh disease (other specified cerebral degeneration - child)
277.2 Lesch-Nyhan (other disorders of purine and pyrimidine metabolism)
330.0 Metachromatic leukodystrophy (leukodystrophy)
272.7 Niemann-Pick (lipidoses)
270.1 PKU (phenylketonuria)
330.1 Tay Sachs (cerebral lipidoses)
275.1 Wilson disease (disorders of copper metabolism)
448.0 Hereditary hemorrhagic telangiectasia
V17.6 Family History of chronic respiratory disease - other
METABOLIC: new codes October 1, 2004 277.85 Disorders of fatty acid oxidation metabolism - Carnitine palmitoyltransferase deficiencies (CPT1, 2)
Glutaric aciduria type II (type IIA, IIB, IIC)
Long chain/very long chain acyl CoA dehydrogenase deficiency (LCHAD)
Medium-chain acyl-CoA dehydrogenase deficiency (MCAD)
Short-chain acyl-CoA dehydrogenase deficiency (SCAD)
Excludes: 277.81 Primary carnitine deficiencies 277.86
Disorders of peroxisomal metabolism new codes October 1, 2004
Adrenomyeloneuropathy
Infantile Refsum disease
Neonatal adrenoleukodystrophy
Rhizomelic chondrodysplasia punctata
X-linked adrenoleukodystrophy
Zellweger syndrome
277.87 Disorders of mitochondrial metabolism
Kearns-Sayre syndrome
Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS syndrome)
Myoclonus with epilepsy and with ragged red fibers (MERRF syndrome)
Mitochondrial neurogastrointestinal encephalopathy syndrome (MNGIE)
Neuropathy, ataxia and retinitis pigmentosa (MARP syndrome)
Excludes:
271.8 Disorders of pyruvate metabolism
377.16 Leber optic atrophy
330.8 Leigh subacute necrotizing encephalopathy
331.81 Reye syndrome
796.6 Abnormal findings on neonatal screening
Excludes: Nonspecific serological evidence of HIV
Neurocutaneous Conditions
237.71
Neurofibromatosis,
Type I
237.72 Neurofibromatosis, Type II
759.5 Tuberous sclerosis
Neuromuscular Conditions
290.10 Presenile dementia
334.8 Ataxia telangiectasia
(other spinocerebellar diseases)
356.1 Charcot Marie Tooth
Disease (peroneal muscular atrophy)
359.1 Duchenne / Becker Muscular
dystrophy (hereditary progressive muscular dystrophy)
359.1 Facioscapulohumeral
(FSHMD) (hereditary progressive muscular dystrophy)
359.1 Limb Girdle MD (hereditary
progressive muscular dystrophy)
334.0 Friedreich Ataxia
333.4 Huntington disease
359.8 Mitochondrial myopathy
(other myopathies)
359.2 Myotonic dystrophy
(myotonic disorders)
359.1 OPMD (Hereditary progressive
muscular dystrophy)
335.0 Spinomuscular atrophy,
type I (Werdnig-Hoffmann disease)
335.11 Spinomuscular atrophy,
type II (Kugelberg-Welander disease)
335.19 Spinomuscular atrophy,
type III (other spinal muscular atrophy)
334.2 SCA (primary cerebellar degeneration)
Skeletal / Connective Tissue Disorders
756.0 Craniosynostosis
(anomalies of skull and facial bones)
756.4 Achondroplasia (chondrodystrophy)
756.51 Osteogenesis imperfecta
756.56 Multiple epiphyseal dysplasia
756.83 Ehlers-Danlos
759.82 Marfan Syndrome
783.4 Short Stature (lack of expected normal physiologic development)
Prenatal
Diagnosis Clinic
655.1Fetal
Chromosomal Abnormality, known or suspected
655.12 Chromosome Abnormality in fetus ("2" added for delivered with mention of postpartum complication)
655.13 Chromosome Abnormality in Fetus ("3" added for antepartum)
655.10 Unspecified
655.83 Amnionic band sequence
655.9Known or suspected fetal anomaly
659.5 Elderly primigravida (advanced maternal age, first pregnancy)
659.6 Elderly multigravida (advanced maternal age,
second or greater pregnancy)
793.6 Abnormal findings, ultrasound
Signs, Symptoms, and Ill-defined Conditions
308.3 Other acute reactions to stress, including acute situational disturbances
795.2 Abnormal Chromosomal Analysis
792.3 Abnormal findings, Amniotic Fluid
634.90 Spontaneous Abortion (also code symptoms)
637 Unspecified Abortion
646.0 Repeated spontaneous abortus
646.3 Repeated spontaneous abortus (currently pregnant)
646.83 Abnormal triple screen (primary)
659.63 Abnormal findings on antenatal screen
659.53 AMA (Advanced Maternal Age) Pregnancy
Screening / Related Codes
V23.0 Pregnancy with History of Infertility
V23.5 Pregnancy with Poor Reproductive History (stillbirth,
neonatal death)
V23.8 Other High Risk Pregnancy
V23.81 Elderly primigravida
V23.82 Elderly multigravida
V23.9 Unspecified High Risk Pregnancy
V26.35 Encounter for testing of male partner of habitual aborter
V26.4 Procreative Management - Genetic Counseling
V28.0 Screen, Chromosome anomalies by amniocentesis
V28.3 Screen, Fetal Malformation by ultrasound (also
ultrasound high resolution fee)
V28.1 Screen, alpha-fetoprotein on amniotic fluid
Laboratory CPT Codes
- Blood Draw /
Phlebotomy 36415-002
- Skin Biopsy 11100-007
- HCG Quantitation 84702
- ACHE 82012
- MSAFP 82105
- AFAFP 82106
- Amino Acids Plasma 82130
- Quantitative Estriol
82677
- Hemoglobin Electrophoresis
83020
- Nucleic Acid Probe (each)
83896
- Nucleic Acid Probe w/Amplication
(PCR) 83898
- DNA Interpretation and
Report 83912
- Cancer Antigen Immunoassay
86316
- Cell Culture, Lymphocytes
88230
- Cell Culture, Tissue
88233
- Cell Culture, Amnio/CVS
88235
- Cell Culture, Bone Marrow
88237
- Cell Culture, Other Tissue
88239
- Blood Chromosomes, Bloom
syndrome 88245
- Blood Chromosomes, Fanconi
syndrome 88248
- Blood Chromosomes, Fra(X)
88250
- Chromosome Analysis,
5 Cell, Karyotype 88261
- Chromosome Analysis,
Routine 88262
- Chromosome Analysis,
Post BMT 88262-22
- Additional Tissue 88262-51
- Chromosome Analysis,
Mosaic 88263
- Chromosome Analysis/Karyotype
(Amnio) 88267
- Chromosome Analysis/Karyotype
(CVS) 88267-22
- Chromosomal Analysis/Karyotype
(In situ) 88269
- Additional Karyotype
88280 Additional Banding 88283
- Additional Cells Counted
88285
- Additional High Resolution
88289
- Handling Fee/Transfers
To Lab (shipping) 99000
- 88271 X 5 Molecular cytogenetics, DNA probe, each (code applied 5 times, once for each
probe in the assay)
- 88275 Interphase in situ hybridization, count 100-300 cells
- 88291 Molecular cytogenetics, interpretation and report
Revised
January 23, 2009
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