Suhel Posted Tue 28th of January, 2014 18:18:26 PM
I am not getting paid for the 3-part stool hemocult test that we hand out to the patient to do at home and mail the test kit back to us. I use CPT code 82270 with Dx code V76.51 (female) and V76.44 (male). I know its a small ticket item but i would like to get paid as we hand these out a lot to our patients.
Thanks in advance.
SuperCoder Answered Wed 29th of January, 2014 16:56:52 PM
When the physician gives the patient a stool hemocult (fecal occult blood test, FOBT) test card for multiple stool collections (usually three) and orders a screening test in the absence of signs or symptoms, you should report 82270 with diagnosis code V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; rectum). If you’re having problems with denials, you might check with your payer about a preference for one of these codes. There is no distinction for male versus female patients. The code you mentioned, V76.44, is incorrect for an FOBT – that’s the code for prostate cancer screening. You would surely get denials using that code.
Also, there are frequency limits for a screening test, which could be leading to denials. For beneficiaries aged 50 or older, Medicare will pay for one covered screening FOBT per year.
If the test is not screening, but ordered for signs or symptoms, the coding is completely different.
Suhel Posted Tue 11th of February, 2014 21:30:26 PM
Thank you for your detailed reply. Could you please let me know which codes would be used if the test is done for diagnostic purposes or for medical necessity?
SuperCoder Answered Fri 14th of February, 2014 11:05:23 AM
82270 - Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)
82271 - . other sources
82272 - Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening
82274 - Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations