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The CPT® Code 96040 refers to medical genetics and genetic counseling services that are provided in a face-to-face setting with the patient or their family. This service is typically delivered by a trained genetic counselor who specializes in understanding genetic disorders and their implications. The primary goal of genetic counseling is to assist patients and their families in comprehending the complexities of diagnosed genetic disorders or the potential for such disorders to occur. During the counseling session, the genetic counselor begins by gathering a comprehensive family genetic history, which may involve creating a family pedigree chart. This chart visually represents the occurrence of genetic disorders within the family lineage, helping to identify patterns and risks associated with genetic conditions. The counselor evaluates the specific risk factors for the patient and their offspring regarding the likelihood of carrying or inheriting the genetic disorder in question. Following this assessment, the genetic counselor provides detailed explanations about the disorder itself, including its medical implications, expected progression, and available medical interventions that can help manage the condition. Additionally, the counselor discusses the hereditary aspects of the disorder, outlining the risks of occurrence for both the patient and their future children. In cases where a known fetal genetic disorder is present, the genetic counselor presents various options for addressing the situation, taking into account the family's risk tolerance, ethical considerations, and personal beliefs. Furthermore, if a child or another family member is affected by a genetic disorder, the counselor plays a crucial role in helping the family adjust to the needs of the affected individual, while also addressing their emotional responses, fears, and concerns related to the diagnosis. It is important to report code 96040 for each 30 minutes of face-to-face counseling provided to the patient and/or their family.
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The following indications outline the circumstances under which medical genetics and genetic counseling services are performed:
The procedure for providing medical genetics and genetic counseling services involves several key steps, each designed to ensure a comprehensive evaluation and support for the patient and their family:
Post-procedure care following genetic counseling services typically involves follow-up communication to address any additional questions or concerns that may arise after the initial counseling session. The genetic counselor may provide resources and referrals for further support, including connections to support groups or additional medical specialists if needed. It is essential for families to have ongoing access to information and support as they navigate the implications of genetic disorders in their lives. The genetic counselor may also recommend periodic follow-up sessions to reassess risks and provide updated information as new research or medical advancements occur.
| Short Descr | GENETIC COUNSELING 30 MIN | Medium Descr | MEDICAL GENETICS COUNSELING EACH 30 MINUTES | Long Descr | Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family | Status Code | Bundled Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GZ | Item or service expected to be denied as not reasonable and necessary | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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Action
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Notes
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| 2024-12-31 | Deleted | Code Deleted. See 96041 |
| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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