Documenting Pharmacogenomic Testing with CPT Codes

J AHIMA. 2016 Jan;87(1):56-9.

Abstract

Pharmacogenomics is the study of how genetics can impact drug response and it aims to maximize therapeutic efficacy while minimizing adverse drug effects in individual patients. The current push for “personalized” approaches to medicine has brought pharmacogenomics to the attention of the healthcare community and the general public. It has been established that the efficacy or safety of certain drugs is impacted in part by the presence of genetic variants and/or other biochemical factors, which may contribute to variable drug response. Consequently, pharmacogenetic testing has been recommended by the FDA to guide the therapy with certain drugs in specific therapeutic settings. As the utilization of pharmacogenetic tests become more ubiquitous in healthcare, there will be a greater need to understand how to document these tests using current procedural terminology (CPT®) codes for the purposes of billing, reimbursement, and recordkeeping. Prior to 2012, most pharmacogenomic tests were considered “molecular pathology” procedures and documented as such. This practice resulted in non-specific documentation that often did not accurately reflect the actual tests performed. The American Medical Association addressed this problem in 2012 and new CPT codes were created to allow for easier, more specific documentation of pharmacogenomic tests. The goal of this article is to provide insight on the status of pharmacogenomic testing, as well as to highlight examples of current CPT codes for tests recommended by the FDA or drug manufacturers to assist in drug therapy. As the utilization of pharmacogenomic testing becomes more widespread, knowledge of how to document these tests will become more valuable.

MeSH terms

  • Clinical Coding*
  • Current Procedural Terminology*
  • Drug Monitoring / classification*
  • Pharmacogenetics*