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Gastroenterology Coding Alert

Reader Question:

A Screen Is a Screen Is a Screen

Published on Sun Aug 31, 2003

Question: We screened a Medicare patient for colorectal cancer with a fecal-occult blood test. She had no signs or symptoms when we tested. The test revealed blood in the stool. Should I code for the finding or for the screen? Will Medicare pay for this?

North Carolina Subscriber

Answer: Code for the screen, using diagnostic code V76.50 (Special screening for malignant neoplasms; intestine, unspecified) as your primary diagnosis and HCPCS code G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) for the procedure code. (For more information on North Carolina Cigna Medicare's instructions on fecal-occult blood tests, please see policy 97-017. You can access the policy online at http://www.cignamedicare.com/partb/bltin/all/98bltin/gr98_1/nc/hemoccult_lmr_policy.html.)
 
NC Cigna Medicare's coverage guidelines for reimbursement on fecal-occult blood testing are similar to most other local Medicare carriers across the country and depend on the following factors:

 

  • The patient must be over 50.
     
  • The test will be reimbursed once per 12-month period.
     
  • Service should be billed (and will be reimbursed) once, even though multiple specimens are checked.
     
  • Coverage is extended for "guaiac-based test[s] for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools."
     
  • "Coverage is available only if the test is ordered in writing by the beneficiary's attending physician. The term 'attending physician' is defined to mean a doctor of medicine or osteopathy (as defined in Section 1861(r)(1) of the Social Security Act) who is fully knowledgeable about the beneficiary's medical condition, and who will be responsible for using the results of any examination performed in the overall management of the beneficiary's specific medical problem."

     Note: Ask your local carrier for coverage details.

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