Colliemom
Expert
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?
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?