Wiki G0328 - claim for a Medicare patient

[alyssak88]

Hi, I am working on a claim for a Medicare patient. A G0328 COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS was performed. The diagnosis used was a screening V7641. The first test was done and results were abnormal. We did a second test to confirm and again results were abnormal. It was billed again as a screening V7641 and Medicare denied it, which makes sense because only one screening is allowed per 12 months. I do not think the second one should of been diagnosed as a screening test becuase we already knew from first test that results were abnormal. Does anyone know what diagnosis code to use in a case like this? Oh and if anyone is wondering an ABN was not signed by patient! Thank you.

 

[Teresa Collins]

Yes, I think you are correct in that the second test would not be considered screening as it was performed due to "abnormal" results. Did the test show blood in the stool? If so, perhaps rectal bleeding would be what you need to code.

I hope this helps.

 

[alyssak88]

G0328

Thank you, the patient did have blood in stool that is why we repeated the test the second time but that is not on the LCD for G0328. I am pulling my hair out! Thank you for your response!