Gastrointestinal pathogen 87507

monatuccillo

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I am not getting paid for this CPT code 87507 Gastrointestinal Pathogen Panel from BCBS..they are saying this investigational and will not be paid. Anyone has any idea what CPT code I can use instead or any help with this will appreciated::confused:
 

CodingKing

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That's the code for what was performed so using "another" code would be misrepresentation of service

Per Blue Cross website:

https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/identification_of_microorganisms_using_nucleic_acid_probes.pdf

The evidence for the use of a nucleic acid-based gastrointestinal pathogen panel in individualswho have signs and/or symptoms of gastroenteritis includes prospective and retrospectiveevaluations of the tests’ sensitivity and specificity. Relevant outcomes include test accuracy andvalidity, other test performance measures, symptoms, and change in disease status. The evidencesuggests that gastrointestinal pathogen panels are likely to identify both bacterial and viralpathogens with high sensitivity, compared with standard methods. Access to a rapid method foretiologic diagnosis of gastrointestinal infections may lead to more effective early treatment andinfection-control measures. However, in most instances, when a specific pathogen is suspected,individual tests could be ordered. There may be a subset of patients with an unusual presentationwho would warrant testing for a panel of pathogens at once, but that subset has not been welldefined. The evidence is insufficient to determine the effects of the technology on healthoutcomes.
 

monatuccillo

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That's the code for what was performed so using "another" code would be misrepresentation of service

Per Blue Cross website:

https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/identification_of_microorganisms_using_nucleic_acid_probes.pdf

The evidence for the use of a nucleic acid-based gastrointestinal pathogen panel in individualswho have signs and/or symptoms of gastroenteritis includes prospective and retrospectiveevaluations of the tests’ sensitivity and specificity. Relevant outcomes include test accuracy andvalidity, other test performance measures, symptoms, and change in disease status. The evidencesuggests that gastrointestinal pathogen panels are likely to identify both bacterial and viralpathogens with high sensitivity, compared with standard methods. Access to a rapid method foretiologic diagnosis of gastrointestinal infections may lead to more effective early treatment andinfection-control measures. However, in most instances, when a specific pathogen is suspected,individual tests could be ordered. There may be a subset of patients with an unusual presentationwho would warrant testing for a panel of pathogens at once, but that subset has not been welldefined. The evidence is insufficient to determine the effects of the technology on healthoutcomes.
So what do you suggest I should do I have several claims like that and BCBS NJ is not paying them at all?
 

CodingKing

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You can appeal. Policy states its Experiential and investigational which is the basis they are using to deny.
 

Tara0513

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Coding king

Is there any way you would be willing to discuss this with Mona and myself??? You seem very educated in this field,and we would love to pick your brain. If at all possible. Please let us know if you are willing to talk to us. mtuccillo@metrohealthbill.net
Thank you!!!
 
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