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efuhrmann

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My coworker codes for the GI docs in our multispecialty clinic and has asked me to pose this question so excuse any spelling errors. How does one code for a clo test? Does it get reimbursed by Medicare?
 
CLO test

You would code for the EGD w/bx - 43239. I'm assuming that's how the sample was obtained? And if the CLO is positive, use dx 537.89. If the CLO test is negative, use the dx that the patient presented for. Not sure if this is paid by Medicare. Anyone else? This test is done to identify H. pylori. The path results must say "positive for H. pylori" to use the h. pylori dx. It cannot just read "positive" (537.89). That's how I would do it.
 
not my area of expertise, but isn't the CLO-TEST, a breath test? CLO is short for "Camplyobacter-like organism" - CPT test 78267/78268 OR the blood test 86625...

???? like I said, not my area of expertise, but I just don't see how a clo-test equals out to an EGD w/biopsy CPT code????
 
Clotest

We bill medicare for the H. PYLORI / CLOTEST w/ code 87077 -QW. Medicare does reimburse, we also private carriers without modifier.
 
CLO test

efurhmann.....how was the sample obtained? I have billed several EGD's w/bx for a CLO test.
 
I have been billing my tests for H-pylori as an EGD with biopsy. And if it is positive for H-pylori then I use code 041.86, where does the 537.89 come in to play?
 
We are billing the biopsy and 87077-QW to Medicare but it is being denied with "CO-16" so now at least I know it is coded correct and can research what information is missing. Thanks for all that responded.
 
Clia

The 87077 is a clia waived test, signified by the QW for Medicare & only used for Medicare billing. Although we do have a clia number which appears on our claims.
 
From my understanding there are different approaches to CLO testing one being endoscopic, one being stool, and yet another being a breath test requiring the use of mass spectrometry. It was determined by the US National Library of Medicine that the CLO test was a rapid and Sensitive method to testing for the H.Pylori organism as well as an unreliable means for diagnosing the condition in patients with a post surgical status (gastric) and therefore I would not feel comfortable with coding a disorder from a positive testing indication, unless the providers documentation supports specifically the H. Pylori infection. I would instead code 796.4 (Abnormal Clinical Findings) as well as any indications for the CLO test (I.e., epigastric pain).

http://www.ncbi.nlm.nih.gov/pubmed/10592826
http://www.ncbi.nlm.nih.gov/pubmed/10656217
 
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