Distinguish Between Screening and Diagnostic to Get Paid for Fecal-occult Blood Tests
Published on Mon Jan 01, 2001
"Most ob/gyns agree that administering a fecal-occult blood test, particularly to patients older than 50, is an important screening tactic for early detection of colorectal cancer. But because of Medicares sometimes-confusing rules about what is and isnt covered regarding preventative or screening care, ob/gyns who administer these tests arent always certain whether it is a covered benefit. Coding when the test is for screening purposes versus when it is not also presents challenges. Diagnostic tests require different ICD-9 codes than screening exams, and no two state Medicare policies seem to agree on a policy for the tests. The key to getting reimbursed for fecal-occult blood tests is to distinguish between screening and diagnostic and to link the correct diagnoses code to the correct procedure code.
Fecal-occult blood tests have two different procedural codes:
HCPCS code G0107 colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations.
CPT code 82270 blood, occult; feces, 1-3 simultaneous determinations.
In either case, the physician is administering the exact same test in the same manner. The two tests even reimburse at about the same rate, around $3.50. So what is the difference?
Code G0107 is for a screening test. It is administered to patients older than 50 who have no signs or symptoms of colorectal cancer. It is done as a precautionary measure when patients reach an age when they are at higher risk for developing colon cancer. Medicare will pay for one G0107 test every year for patients over 50 years of age, and there must be at least 11 months in between the annual tests. According to Melanie Witt, RN, CPC, MA, an independent coding educator, Medicare added some screening tests in 1998. Prior to 1998, they would pay only for a screening Pap smear. Medicare calls this screening rather than preventative care because of their policy against paying for preventive care, Witt says. But they recognize that there are patients who are in a high-risk group because of their age who have a greater likelihood of developing disease. This increased recognition of high-risk groups has been beneficial to women on Medicare, as the program now pays for periodic routine screening exams for breast cancer, cervical cancer and other diseases of the female reproductive system. Like these other screening services, G0107 is a preventive step to look for early signs of colorectal cancer. The Medicare standard is now to cover the test every year to patients older than 50, even if no symptoms are present.
Code 82270 is for a diagnostic test. It is administered when the patient shows signs or symptoms of colorectal cancer, like blood in the stool, for example. If the patient has symptoms that [...]
