Gastroenterology Coding Alert

Medicare limits payment to 1 screening every 12 months

When the physician orders/performs fecal occult blood testing (FOBT) for a Medicare patient to screen for colorectal cancer in the absence of signs and symptoms, you should report G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) rather than 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]).

The difference: Code 82270 describes a diagnostic test. The physician provides the service when the patient shows signs or symptoms of colorectal cancer, such as blood in the stool.

-If the patient has symptoms that lead the physician to believe that she must look for gastrointestinal bleeding as a sign of colon surface inflammation, you should report 82270,- say Melanie Witt, RN, CPC, MA, an independent coding consultant in Guadalupita, N.M. 

Code G0107, in contrast, describes a screening procedure. For instance, the physician administers the test to patients older than 50 years of age who have no signs or symptoms of colorectal cancer as a precautionary measure.

Non-Medicare payers are different: For payers other than Medicare, you should report 82270 for both diagnostic and screening FOBT.

What's the frequency? Medicare will cover screening FOBT (G0107) once per year for patients over the age of 50.

In addition, Medicare holds that you must report an appropriate screening diagnosis code, such as V76.5x (Special screening for malignant neoplasms, intestine ...).