Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Ohio 44195, USA.
Genet Med. 2011 Dec;13(12):1011-4. doi: 10.1097/GIM.0b013e3182296344.
: In 2007, CPT® code 96040 was approved for genetic counseling services provided by nonphysician providers. Because of professional recognition and licensure limitations, experiences in direct billing by genetic counselors for these services are limited. A minority of genetics clinics report using this code because of limitations, including perceived denial of the code and confusion regarding compliant use of this code. We present results of our approach to 96040 billing for genetic counseling services under a supervising physicians National Provider ID number in a strategy for integration of genetics services within nongenetics specialty departments of a large academic medical center.
: The 96040 billing encounters were tracked for a 14-month period and analyzed for reimbursement by private payers. Association of denial by diagnosis code or specialty of genetics service was statistically analyzed. Descriptive data regarding appointment availability are also summarized.
: Of 350 encounters January 2008 to February 2009, 289 (82%) were billed to private payers. Of these, 62.6% received some level of reimbursement. No association was seen for denial when analyzed by the diagnosis code or by genetics focus. Through this model, genetics appointment availability minimally doubled.
: Using 96040 allowed for expanding access to genetics services, increased appointment availability, and was successful in obtaining reimbursement for more than half of encounters billed.
2007 年，CPT® 代码 96040 获批用于非医师提供者提供的遗传咨询服务。由于专业认可和许可限制，遗传咨询师直接计费提供这些服务的经验有限。少数遗传诊所报告使用该代码是因为存在限制，包括认为该代码被拒绝和对合规使用该代码感到困惑。我们介绍了在大型学术医疗中心的非遗传专业部门内整合遗传服务的策略下，我们使用监督医生的国家提供者 ID 号对遗传咨询服务的 96040 计费的方法。
对 96040 计费就诊进行了 14 个月的跟踪，并分析了私人支付者的报销情况。通过统计分析，我们分析了遗传服务的诊断代码或专业拒绝的关联。还总结了有关预约可用性的描述性数据。
2008 年 1 月至 2009 年 2 月期间的 350 次就诊中，289 次（82%）向私人支付者收费。其中，62.6%的人获得了一定程度的报销。通过分析诊断代码或遗传焦点，未发现拒绝的关联。通过这种模式，遗传咨询预约可用性增加了一倍。
使用 96040 可以扩大获取遗传服务的机会，增加预约可用性，并成功为超过一半的计费就诊获得报销。
