Gastroenterology Coding Alert

Hint: Concentrate on intent of the test for better coding efficiency.

When your gastroenterologist performs a fecal occult blood test (FOBT), your key to selecting the right code is identifying the purpose of the test. Our strategies that follow will guide you to FOBT claims success.

Reserve 82270 For Colorectal Cancer Screening

If your gastroenterologist is providing a take-home FOBT to the patient for the purpose of colorectal cancer screening, you need to report the procedure with 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [i.e., patient was provided 3 cards or single triple card for consecutive collection]). The patient carries the test cards and obtains consecutive samples himself and then returns with the cards or mails the cards back to the office. You should report the FOBT on the day the sample cards are received in your office.

Keep in Mind: Though the patient tests three different stool samples with either three separate single test cards or on a single triple card, you should not report 82270 for each of the samples. So regardless of the number of samples the patient returns with, you still continue to code only one unit of 82270. "Also keep in mind that the guideline from the United States Preventative Health Task Force only recommends FOBT testing for colorectal cancer screening once per year," says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA's CPT® Advisory Panel. "You should expect a denial if the code is used before a full calendar year has passed from the previous FOBT claim. You might also receive a claim denial if the FOBT was performed within 5 years of a routine screening colonoscopy."

Example: A 65-year-old male patient comes for a routine checkup to your gastroenterologist. The patient has a family history of colorectal cancer. Your gastroenterologist provides the patient with a take home FOBT test card to collect samples and instructs the patient how to perform the procedure to collect the samples. Even though he was provided with three sample cards, he returns the next week saying that he was only able to collect two samples and provides them to your gastroenterologist.

What to code: You report 82270 for the FOBT with the date of service indicating the date on which the sample cards were returned by the patient. It is essential to document that the patient was only able to collect two samples for the test.

Switch to 82272 When FOBT is Diagnostic

When a patient turns up with complaints including what appears to be rectal bleeding, your gastroenterologist might order a FOBT test to assess the symptoms the patient is experiencing. In such situations, you cannot use 82270 as it is a specific FOBT test for colorectal cancer screening. Here you would report the procedure with 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening).

Note:You can resort to using 82272 for samples that the patient collects using a home FOBT kit as well as when your gastroenterologist derives a sample through digital rectal examination (DRE). However, you can't report 82270 unless the patient collects the samples himself using the home FOBT kit specifically for the purpose of routine colorectal cancer screening.

Example: A 63-year-old male patient presents to your gastroenterologist with complaints of rectal bleeding. Your gastroenterologist undertakes a comprehensive evaluation and records a thorough history of the patient. He then performs a digital rectal examination to assess the patient's symptoms. During the procedure, your gastroenterologist collects a specimen of feces and proceeds to undertake a FOBT on the specimen collected.

In this case scenario, you will have to code the FOBT with 82272 as the patient presented with symptoms of bleeding and melena. You cannot use 82270 as the purpose of the test was not screening for a colorectal neoplasm. Don't forget to report 569.3 (Hemorrhage of rectum and anus) to 82272 to support the necessity of the occult blood test.

Capture G codes for Immunoassay Tests on Medicare Patients

Instead of using a take-home kit for FOBT, your gastroenterologist might rely on the use of a fecal immunoassay test kit for occult blood, also known as FIT. If your gastroenterologist prefers to use immunoassay for FOBT, you can report G0328 (Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous) on your claim for colorectal cancer screening of Medicare patients. "There was a G code for standard FOBT stool tests for colorectal cancer screening in Medicare patients, but it was eliminated in favor of using 82270," adds Weinstein.

But if the purpose of using the immunoassay FOBT is to test for occult blood to assess the patient's symptoms, you can rely on reporting the procedure with 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations).

Reminder: Don't forget to document the right date of service for the FOBT. You should use the date as the day on which the sample was actually tested. For example, if your gastroenterologist received a sample for testing on Monday and the FOBT immunoassay test was completed on Wednesday, you will record the day of service as Wednesday and not Monday.

Coding Tip: If testing for occult blood is done using a sample other than the patient's feces (urine or vomited liquid), you cannot use 82270 or 82272. Instead, you will have to use 82271 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; other sources) to report the test procedure.