READER QUESTIONS:
Update Your Fecal Occult Guidelines
Published on Mon Apr 10, 2006
Question: Does anyone bill G0107 with Medicare's annual G0101 and get paid for it? I was told that it is bundled in if done with the annual. But I can bill at another visit, such as 99213-25 with G0107. Is this correct? How does the ob-gyn get reimbursed for the digital exam with one card?
Arkansas Subscriber
Answer: Medicare only pays for the hemoccult screening test when the patient collects the sample. That is what G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) is for. The same rule applies to G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations).
If your ob-gyn collects the specimen in the office, it is not a screening test but diagnostic, so your ICD-9 code must reflect that (like rectal bleeding or tarry stools).
CPT has also changed the codes this year to reflect that the only good screening for colorectal cancer for this type of test is when the patient collects the sample. Therefore you cannot report 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [i.e., patient was provided three cards or single triple card for consecutive collection]) to private insurers unless you meet the criteria.
If the physician collects the sample, it is not a screening test, and the code is 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) with an appropriate non-screening diagnosis.
Heads up: You would not bill Medicare until you get the card back for testing. Some practices give the patients the cards prior to the visit to have them bring them back in for the exam to complete the test. So the bottom line is this: Your ob-gyn will not get reimbursed for the digital exam sample unless he performs it for diagnostic reasons.
