Wiki Cms denial of cpt code 82270

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robbiehogstad

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What the correct code for blood occult? I've also found G0328 ~ but we are getting all of them back stating we are billing the wrong code??

Anyone else having this issue?

Thank you

Robbie:eek:
 
Are you reporting the correct diagnosis? 82270 is the screening code, for fecal occult (guaiac) which should have a V-code diagnosis, such as V76.41, not a symptom diagnosis. One of these fecal occult screenings is allowed each year if the patient is over 50, whether you result only one or all three of the cards...so make sure you're not billing one at the time of service and the other two when they get sent back, or they'll deny as a dupe.

The 82272 is used when the patient has a symptom, such as rectal bleeding, and the coverage is pending deductible and co-insurance.

The G0328 does not specify guaiac, but there are other FOBT tests out there that use immunoassay rather than the peroxidase, so it might be appropriate depending on your methodology. Check your local policy to see if they prefer this code over 82274.

Let me know what you find out.
 
This was just discussed in our office today.... So let me clarify- If the doctor uses one card in the office on a patient for a screening (during a physical) then we would bill 82270 (one time). Also, If the patient sends in 3 cards over a period of time even though there are 3 cards we would only be able to bill for the 82270 1 time--- correct?

Thanks,

MM:)
 
Both tests are based on 1-3 samples

82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)

G0328 Colorectal Cancer Screening; fecal occult blood test, 1-3 simultaneous determinations (Immunoassay-based fecal-occult blood tests)

both of these are screenings so DX V76.51 and coded with 1 unit. G0328 is MCare only


82272 Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening

this is diagnostic so DX is whatever the sign/symptom is and still coded with 1 unit

MCare fee schedule
82270 is $4.66
G0238 is $22.78
82272 is $4.66
The reimbursement difference is dependent on how the test was performed (see bolded)

The MCare preventive cheat sheet shows both 82270 and G0328 but states "check with carrier"
http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
 
my office is having an issue with getting these codes paid....we bill 82274 to commercial insurance with v76.41 and G0328 to medicare also with v76.41...the insurance companies are not paying. Please help!!!

Any suggestions will be appreciated!!
 
DoDCoder4You said:
Well.. We Billed 82270 with V76.51 and it was Denied by Medicare.
So now i'm trying to find if we can use the G0328.
Click to expand...

G0328 QW is allowed by Medicare, but you have to use the QW modifier to indicate it is a CLIA waived test.
 
When is it appropriate to bill G0328

Can someone clarify for me when it is appropriate to bill G0328? We are being told by a Medicare Advantage plan that we can bill it once we give the patient the cards on which to collect samples. They want us to document that we have ordered the FOBT using G0328. However I am confused as to why we would bill it if we are simply giving the patients the order and the collection materials to send to the lab.
 
G0383-need modifier-medicare not allowed

Can you suggest-as*per*review*clm*dnd*as*CPT*inconsist*w/modifier*or*mod*is*miss,*and*as*per*the*MCR*eob*cpt*G0283*does*not*have*any*modifier-

Which modifier we append for G0283
 
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