ED Coding and Reimbursement Alert

Question:  Can we bill for the guaiac test?


Texas Subscriber


Answer: You may be able to bill for this test, depending on where you-re located and what codes you usually report. If you-re in a hospital emergency department setting, you won't be able to bill for it. But if you-re in an urgent care setting, you might.

The guaiac test is a lab test for stool or stomach contents. This means that whoever bills for the test must have a CLIA (Clinical Laboratory Improvement Act) license and provide all the equipment, supplies, and expenses that accompany administration of the test. 

In a hospital ED, the facility holds the license and bears the expenses of the supplies and staff for the test. So, unless your practice has an agreement with the facility that you can bill for guaiac tests--and a CLIA license, ownership of the needed supplies, and a physician administering the test--you can't bill for it.

Exception: If your ED physician is working at an office-based urgent care center, your group can bill for the guaiac test if you:

- pay the building's rent
- purchase the supplies for the test
- have a CLIA license
- employ the necessary staff
- bill nonfacility-based E/M codes such as codes 99201-99215 (Office or other outpatient visit for the evaluation and management of a patient ...) instead of 99281-99285 (Emergency department visit for the evaluation and management of a patient ...).

For the latter, report the test with 82270 (Blood, occult, by peroxidase activity, qualitative; feces, 1-3 simultaneous determinations) for the peroxidase method (for stool) or 82273 (-other sources) for other specimens.
 
For the immunoassay method, report 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations).