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[cancer|help] Trying to crowdsource key medical coding info about whole genome sequencing - Lakeshore
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Jay Lake
Date: 2013-04-25 05:37
Subject: [cancer|help] Trying to crowdsource key medical coding info about whole genome sequencing
Security: Public
Tags:cancer, health, healthcare, help, personal
Dad is helping me apply to my insurance company for reimbursement for the Whole Genome Sequencing. While they have been very cooperative, we have inevitably become mired in bureaucratic challenges. We think we have found all the answers except one.

The insurance company wants a CPT code for Whole Genome Sequencing. However, Illumina, the lab that did the work, does not provide CPT codes because they do not bill insurance. They say it takes a specific analysis to identify what CPT codes are appropriate to bill to an insurance company, and that they have no one trained to do this.

Other sources have told us there are various codes for partial genome sequencing and whole exome sequencing, but no one has been able to identify a CPT code for whole genome sequencing. My father has not had any luck with Internet searches.

Does anyone know what the CPT code is for whole genome sequencing, or where to look?

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wyld_dandelyon: Scientist Geek Magician
User: wyld_dandelyon
Date: 2013-04-25 12:40 (UTC)
Subject: (no subject)
Keyword:Scientist Geek Magician
I know the answer is almost certainly"yes", but have you asked the staff at your oncologists' offices?
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Jay Lake
User: jaylake
Date: 2013-04-25 13:00 (UTC)
Subject: (no subject)
Yes. They do not have an answer.
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wyld_dandelyon: Allegedly Sleepy
User: wyld_dandelyon
Date: 2013-04-26 02:36 (UTC)
Subject: (no subject)
Keyword:Allegedly Sleepy
I figured you probably had, but even without chemo-brain, people miss the obvious sometimes.

I'm glad to see you got more useful answers below!
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Jon Hansen
User: jonhansen
Date: 2013-04-25 13:44 (UTC)
Subject: (no subject)
CPT codes are determined by the American Medical Association. There's one of those About pages that covers how to look things up there:
http://patients.about.com/od/medicalcodes/a/How-To-Look-Up-A-Cpt-Code-And-Its-Corresponding-Relative-Value-Amount-Rvu.htm
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a_cubed
User: a_cubed
Date: 2013-04-25 14:23 (UTC)
Subject: From the AMA DB Jonhansen gave
81317 PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis

a search on genome sequence didn't bring it up but "sequence" had 25 hits including three that look to be "full sequence analysis" and this one is for colorectal cancer, the others being different types of cancer (oh, and fuck cancer, while we're talking about the horrible thing).

HTH.
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Dan/Дмитрий: The Sign at the End of the Universe
User: icedrake
Date: 2013-04-25 15:02 (UTC)
Subject: (no subject)
Keyword:The Sign at the End of the Universe
If you're still fighting with this question next week, I know someone who works in medical billing, but I won't see her until Tuesday.
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seventorches
User: seventorches
Date: 2013-04-25 15:31 (UTC)
Subject: (no subject)
Wow. That's like...a first-future problem. Mind bending!
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Dave O'Neill
User: daveon
Date: 2013-04-25 15:45 (UTC)
Subject: (no subject)
Weirdly I have a friend who's company does a lot of CPT related work, I've pinged him.
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Jay Lake
User: jaylake
Date: 2013-04-25 15:46 (UTC)
Subject:
Thank you!
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Dave O'Neill
User: daveon
Date: 2013-04-25 16:58 (UTC)
Subject: Re:
Here's what he gave me.

McKesson has a good list, it's 81161 to 81479, look in the list and see if there is a match for what he is looking for. Basically, 81479 is the catch all, and all the rest are "Panels" for specific additions, deletions or modifications of individual, or groups of genes for a particular disease. The Goal of a CPT is to request that Lab execute on a test, or group of tests to detect or eliminate a condition. CPT Codes aren't the diagnosis code, they are the LAB code for approved groups of tests. http://mptrms.mckesson.com/rs/MckessonPT/images/2013%20Code%20changes%20for%20PATH_LAB_FINAL.pdf
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twirlgrrl
User: twirlgrrl
Date: 2013-04-25 16:43 (UTC)
Subject: (no subject)
I asked a couple of coders; let's see what they say.

EDIT: Answer one comes from an inpatient coder who does not do CPT coding anymore. "81404 seems to be in the neighborhood......but knock on the wrong door, and it may be answered by a armed Texan. there's a site called "Findacode.com", but one needs to subscribe to it. That might be one way to go."

I am still looking for someone I know who carries the outpatient coding credential (CCS or CCS-P.) It's been a while since I worked in that corner of the field.

EDIT the second: Answer coming, from a CCS-P. Her answer is in the same neighborhood as the answer you got above but it's a different code. I'll send you her whole answer with references by LJ message when I get it, if that's OK.

Edited at 2013-04-25 07:52 pm (UTC)
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Jay Lake
User: jaylake
Date: 2013-04-25 20:21 (UTC)
Subject: (no subject)
Thank you!
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