Medicare and Fecal occult blood

kjkar1960

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We are starting to receive denials for 82272( feces specimen test done from a digital rectal exam in the office, for screening.) from Medicare. We are being told it is now a non covered service, but I can't find anything to verify this on the Medicare web site. We are also being told there is no G code conversion for this.
 

Lisa Bledsoe

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CPT revised the definition of 82272 this year. There does not appear to be any code available now for the single card screening at the time of a DRE. I have not seen any information on this either, other than the revised code in CPT. Looks like the single card is bundled with the exam.
 

Cottrell

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This is what I found on the Fecal Occult Test when I researched it:

Screening FOBT: Medicare requires 3 samples
When you are coding a Medicare claim for fecal occult blood tests (FOBT) screening, you'd better make sure the patient has collected the sample in the way prescribed by Medicare. Specifically, CMS requires that samples be taken from three consecutive stools (MCM Section 4180.2). That's in contrast to private payers following AMA rules, which allow one, two or three samples (CPT Assistant, September 2003).
Medicare and private payers treat sample collection for screening FOBTs differently – even though the HCPCS and the CPT definitions contain the same wording (ie, “1-3 simultaneous determinations”).
“The two positions are confusing,” admits Joan Gilhooly, CPC, president of Medical Business Resources, Chicago , Ill. “I tell the coders I work with to be careful. The definitions seem to say the same thing, but that's not how Medicare and private insurers see it.”
And that's not all: Medicare rules can trip you up in another area, she says. CMS requires that the beneficiary collect the three determinations. “Sometimes, our doctors collect a stool sample during a digital rectal exam,” Gilhooly says. “But we can't use that as the first of the three samples. We have to give the patient the take-home test card to conduct the complete test.”

So Medicare is only paying for the 82270 code.

Hope this helps.

Wendy
 
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