Gastroenterology Coding Alert
Third Party Typically Bills for Cologuard
Question: We recently started performing Cologuard™ tests and we aren’t sure how to report these tests to Medicare. Even our payer didn’t have a suggestion. Can you advise? Codify Subscriber Answer: Cologuard™ is only billed under CPT® code 81528 (Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result), but the billing comes from the company which markets the kit, not from the physician’s office; the physician provides a “prescription” (form to fill out as a lab order) and the company then acts on the order and ultimately provides a report to the ordering physician. Therefore, you typically won’t bill for the actual test, only for the E/M service you provide to the patient where you discuss what type of screening to perform and decide to proceed with Cologuard™ testing, or if a subsequent visit is required to review the results (for example, if test is abnormal, this will require patient to understand they should undergo colonoscopy).
Gastroenterology Coding Alert
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Third Party Typically Bills for Cologuard
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