Gastroenterology Coding Alert

Here's why you should avoid reporting 82270 x 3

CPT 2007 promises the deletion of fecal occult blood test (FOBT) code G0107, so you have until Jan. 1 to get up to speed, or you could face some shocking reimbursement problems.

Brush Up on FOBT Basics

What it is: The Medicare Carriers Manual specifies a screening FOBT as -a guaiac-based test for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools.- Medicare will cover an FOBT once every 12 months if the patient:

1. takes the cards home

2. obtains the samples

3. returns them to the physician.

Now: When your gastroenterologist orders an FOBT for screening purposes, you should report either 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 three cards or single triple card for consecutive collection]) or G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations).

In the future: Medicare will delete G0107 as of Jan. 1, 2007. To report this service, you will only use 82270. -This is a good thing for coders,- says Melanie Witt, RN, CPC-OGS, MA, a coding expert based in Guadalupita, N.M. -Now we-re all on the same page with one CPT code instead of having to remember two.-

Watch Out for These Common Mistakes

Prior to 2006, some coders incorrectly interpreted 82270's descriptor of -one to three simultaneous determinations- to mean they should bill each of the three determinations with one unit of 82270 (82270 x 3).

Then in 2006, CPT changed the descriptor for 82270, but Medicare failed to make the adjustment in the corresponding G code for colorectal cancer screening, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel. -Starting in 2007, you will report 82270 only once, no matter if the patient is on Medicare or not.-

Keep in mind: Also, don't confuse 82270 with 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]). Code 82272 was a new CPT code for 2006, Weinstein says.
 
You-ll use it when the gastroenterologist uses the FOBT as a diagnostic tool, rather than a screening one. This code describes a -single specimen- rather than a three-part test.

Further, 82271 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; other sources) is the 2006 CPT code for the test for occult blood by peroxidase activity from sources other than stool. You should use this code for testing gastric aspirates or vomitus.

One Other CPT Change

You don't have to change the way you-ve been reporting inpatient consultation codes, but you should be aware that the descriptors for 99251-99255 delete the word -initial.- This revision accounts for the fact that last year's CPT update deleted the follow-up inpatient consultation codes.