Gastroenterology Coding Alert

You'll need a minimum of 2 samples to report 82270

Beginning Jan. 1, you-ll no longer report 82270 for single-specimen fecal occult blood tests (FOBT). Instead, CPT has added a new code , 82272, for in-office, single-specimen FOBT following digital rectal exam, while you will reserve 82270 for triple-sample FOBT.

Number of Samples Now Key

Revisions to CPT 2006 mean that you-ll no longer assign 82270 for -1-3 consecutive collected specimens with single determinations.- Instead, you should apply 82270 when the patient provides three samples, as per the new code descriptor (new text is underlined):

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)

Two will do, in a pinch: When the physician asks the patient to provide three samples, but the patient only provides two samples, you should -perform analysis of the two collected specimens, report the results accordingly, and record one unit of 82270,- according to CPT Changes 2006: An Insider's View published by the AMA.

Code 82270 is appropriate to evaluate alimentary-tract conditions that could cause intestinal bleeding, unexpected anemia, abnormal signs or symptoms that might be associated with blood loss, and complaints of discolorations in the stool, among other problems.

-We usually provide the three-sample test to patients for colorectal cancer screening or during the workup of an iron deficiency anemia,- says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel.

Know the limits: Under current guidelines, Medicare allows payment for 82270 only once every three months for patients taking nonsteroidal anti-inflammatory drugs.

FOBT After Digital Exam Calls for 82272  

For a single-specimen FOBT following a digital rectal exam, you should report new-for-2006 code 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]).

The AMA specifically revised 82270 (as noted above) and added 82272 to distinguish between -a single- specimen FOBT that is primarily done in the office setting- and -a three-specimen FOBT that the patient typically collects at home,- according to CPT Changes 2006.

-We often perform single determinations for occult blood after an office physical exam and digital sampling in the course of evaluating gastrointestinal symptoms,- Weinstein says.

Look to 82271, Not 82273, for -Other- Sources

For testing samples other than feces, you should now report 82271 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; other sources). The descriptor for 82271 is identical to now-deleted code 82273, and you should apply 82271 in all the same circumstances you would have applied 82273 in the past.