1 in 8 women will develop breast cancer in their lifetime. The switch from ICD-9 to ICD-10 brought more specific codes to better define breast cancer based on the location of the cancer in the breast. New codes have been proposed by the ICD-10-CM Committee to further classify BRCA gene mutations, which are indicators of higher risk for breast and/or ovarian cancer. BRCA1 and BRCA2 are genetic mutations that can be detected through a blood or saliva sample.
There has been an increase in insurance carriers covering prophylactic
mastectomy and/or oophorectomy for patients at high risk of developing cancer. The
need for more specific codes was warranted to identify the specifics of the
mutations for tracking and reporting as well as providing better detail for
The table below depicts the new codes proposed. Oddly, they did not make it into the updates for 2020, but may still be in consideration for future updates.
BRCA1 genetic susceptibility to malignancy of breast
BRCA2 genetic susceptibility to malignancy of breast
Genetic susceptibility to malignant neoplasm of breast,
BRCA1 genetic susceptibility to malignancy of ovary
BRCA2 genetic susceptibility to malignancy of ovary
Genetic susceptibility to malignant neoplasm of ovary
Novitas, a Fiscal Intermediate covering 12 states, quietly updated the Evaluation and Management FAQs on July 15, 2019. It now states that start and stop times are requirements for all time-based evaluation and management services.
The following must be in the patient’s medical record in order to report an E/M service based on time: – The total length of time (start and stop times) of the E/M visit; – Evidence that more than half of the total length of time of the E/M visit was spent in counseling and coordinating of care; and – The content of the counseling and coordination of care provided during the E/M visit.
CMS directives such as the IOM and Evaluation and Management Guidelines show no requirement of start and stop times for time-based services.
Is this an indication that the 2021 E&M changes may enforce start/stop time requirements? Comment your thoughts!
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