[cancer|help] Trying to crowdsource key medical coding info about whole genome sequencing

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?

25 thoughts on “[cancer|help] Trying to crowdsource key medical coding info about whole genome sequencing

  1. Jim Crider says:

    Let me contact the ex, who does medical records coding for part of her living, and see what she thinks. I’ll direct her here.

  2. You might query foundationone.com . They do whole genome sequencing and supposedly they do bill insurance. I will ask my lungcancer forum if anyone has had it done as part of a research study.

  3. mmmmbobo says:

    I spent a bit of time digging into this and I didn’t find anything obvious. In general, the codes relating to genetic testing are very specific to a particular gene or diagnosis (ie: BRCA gene for breast cancer). There did not seem to be any obvious or even particularly reasonable code fits to your situation.

    I think you may be running into a limitation with the system, which is that it is really designed to handle ‘standard’ medical procedures for billing purposes. The whole genome analysis that you had done is still very, new, experimental and cutting edge, thus there really isn’t an established code for it yet.

    That being said, there are some codes that are designed to nonstandard procedures and experiences.
    Somebody that is an expert coder might be able to kluge together a set of these in an appropriate manner to get you reimbursed for at least something. That, however is beyond the scope of my knowledge and abilities. Feel free to email me if you want to discuss further.

  4. Jim Crider says:

    Jay, check your inbox. My ex’s encyclopedic knowledge of where to find stuff in the CPT book appears to have scored.

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