Primary Care Coding Alert

Question: Which diagnosis code does Medicare accept for an occult blood test performed in the office?

Illinois Subscriber

Answer: For coverage of occult blood screening (G0107, Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations), Medicare requires a diagnosis of V76.51 (Special screening for malignant neoplasms; intestine; colon). If you are receiving denials using this diagnosis code, you should check with your carrier for guidelines. It may point out that the test code (G0107), rather than the ICD-9 code (V76.51), is the problem.

Because G0107 states 1-3 simultaneous determinations, some insurers and coding experts place certain restrictions on the test. For instance, some carriers, such as CignaMedicare, require that the patient take home a series of three cards, obtain the samples as directed and return them to the office for testing. They will not reimburse G0107 for only one test done in the office. Coding experts cite the 1997 documentation guidelines, which list obtaining a stool sample as an examination bullet for the gastrointestinal system, as further proof that the physician should include an in-office test in the E/M. Without a national policy on the proper use of G0107, you should get the carrier's guidelines in writing and adhere to its billing requirements.

For a diagnostic occult blood test, you should use 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations). Medicare has a long list of covered diagnoses for this test, which you can find online at www.cms.hhs.gov/ncd/searchdisplay.asp? NCD_ID=167&NCD_vrsn_num=3 as part of Medicare's national coverage policy for this test.

Beth Glenn, CPC, CMA, certified coder for Jefferson Family Physicians in Jefferson City, Tenn., contributed to You Be the Coder and Reader Questions.