Billing and Coding: Genetic Testing for Lynch Syndrome

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34912, Genetic Testing for Lynch Syndrome. Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. It has been recognized that there is some variation in the order of testing based on tissue availability, prevalence, patient history, test availability, testing turn-around time and patient treatment schedule. However, routine MMR germ-line mutation testing is not expected prior to appropriate screening (IHC/MSI). When MSI/IHC testing cannot be performed or is contradictory, claims for MMR germ-line testing exemptions will require the addition of the -KX modifier with the reported Current Procedural Terminology (CPT) code. The -KX modifier specifies that the “Requirements specified in the medical policy have been met. Documentation on file." Documentation is expected to be available upon request. Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.