Wiki Fecal Occult

[mac4511]

Please help!! Say a pt comes in for routine annual pap smear and Dr. does a rectal exam with hemoccult test in the office. How do I bill that and what diagnosis code? We have been billing 82270 which are being denied by Medicare for not medical necessity.

 

[Cpeterson2010]

Medicare accepts the 82270 for fecal occult test and the Diagnosis code of V76.41.

I do not have any issues with it.

Charisse

 

[aslonsky]

These fecal occults can be confusing.

82270 would be for using the 3 single cards or the triple card - in this case normally you would send these home with the patient, and you should not bill until they bring the cards back. The correct screening DX is V76.41 -but you may have to check your Local Medical Review Policy with your Medicare Contractor for their allowed diagnosis.

If you are using the swab and collection tube in the office then you need to be billing 82274 or G0328 - this gets paid at a much higher rate because it is a more accurate test. Our Medicare carrie is Trailblazers and they require the G0328 for this test.

 

[Lisa Bledsoe]

The DRE and single card test are inclusive to the rest of the exam.

 

[mac4511]

Thank you, this information helps.