Gastroenterology Coding Alert

2 situations will allow you to use this new FOBT code

You know that CMS deleted screening code G0107 and that you-re supposed to use 82270 instead -- but do you know how to use the new fecal occult blood test (FOBT) code G0394?

Get the Nitty Gritty on This New Code

You-ve got a new FOBT option in 2007. CMS just introduced G0394 (Blood occult test [e.g., guaiac], feces, for single determination for colorectal neoplasm [e.g., patient was provided three cards or single triple card for consecutive collection]).
 
The reason for confusion: Nobody's quite sure when you-re supposed to use G0394. On the one hand, it's clearly not a screening code because it's not on the -screening list,- says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M. On the other hand, it contains the reference to a -single determination- as well as to providing the patient with cards to obtain two or more samples.

So far, one carrier, Highmark Blue Shield, has weighed in on G0394 and instructed providers to use it for diagnostic FOBTs. That still doesn't explain how you can have a -single determination- as well as three cards, coding experts say.
 
Tip: You should keep using diagnostic code 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) when your physician only collects one sample in the office and doesn't send the patient home with cards, says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.

Rasmussen says one CMS official told her you could use G0394 if the patient is on -high-risk medications that cause GI bleeding.- You would bill this code with a diagnosis of high-risk medication, she says.

Bottom line: There are two situations when you might be able to use G0394, Witt says:

1. The patient comes in with a complaint including rectal bleeding, and the doctor takes a sample in the office to confirm the diagnosis and then sends the patient home with cards to obtain more samples.

2. The patient took cards home to check for rectal bleeding, and as a result of that test, the doctor takes an additional sample in the office.

Important: -Medicare developed this code for Medicare, so I wouldn't use this with any other payers,- Witt says.