Wiki 82270 vs 82272

Colliemom

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We have researched when it is appropriate to bill these two codes. We have determined that:

88272 is billed when service is performed for reasons other than colorectal neoplasm screening, and 1 - 3 cards are used.

88270 is billed when performed as colorectal neoplasm screening, and when 3 cards have been completed.

So when billing 88270, V76.51 would be the appropriate dx. The issue we are having is with assigning a dx code for 88272. Obviously, if there was blood present on a rectal exam, or if the patient indicated he/she had rectal bleeding in the past, then 569.3 would be the appropriate dx. But what if there are no signs/symptoms and only 1 card is done. Since 88270 requires for 3 cards to screen for colon cancer, we cannot use this code. But if 1 card is done, as part of an annual wellness exam, would it be appropriate to bill 88272 with the dx of V70.0?
 
82272 will not be paid with V70.0.... there has to be a problem dx to go along with this code. The January 2013 National Coverage Determinations Coding Policy Manual published by CMS is a great tool to find out which lab tests are covered with certain dx.
 
that's correct, for 82272 to be paid on, you must use a diagnosis code other than V70.0, I would use something along the lines of rectal bleeding, etc. for this one.

for 82270 the correct diagnosis is V76.51, colon cancer screening, but that's for a physical

Hope that helps :)

~Stephanie Garrison, CPC
 
Please clarify for me:

Provider performs preventive/gyn exam and performs hemocult. Is this included in preventive/gyn exam? Can I bill out as 82272? I have a provider who performs a guaiac stool everytime they perform preventive/gyn exam.

Thanks so much.
 
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