Gastroenterology Coding Alert

Question: How do I code a fecal occult blood testQuestion: How do I code a fecal occult blood test (FOBT) to screen a Medicare patient for colorectal cancer? She doesn't present signs or symptoms of the disease.
Florida Subscriber

Answer: When the physician orders or performs an FOBT for a Medicare patient to screen for colorectal cancer in the absence of signs and symptoms, you should report 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]). There was a period when you reported G0107 (colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) for FOBTs for Medicare patients, but those days are over.

Another option: As an alternative to the standard take-home FOBT, the physician might conduct an immunoassay FOBT. The immunoassay screening uses a spatula or special brush to collect the samples.

For Medicare patients older than 50, report G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations) when the physician performs an immunoassay FOBT. To report the G0328 screening, you must have a written order from the beneficiary's attending physician.

How often? Medicare will cover a screening FOBT once every 12 months for patients over the age of 50. Medicare holds that you must report an appropriate screening diagnosis code, such as V76.5x (Special screening for malignant neoplasms, intestine ...).

Smart move: For optimal FOBT claims, always make sure you have the proper date of service in the documentation. Your best bet is to use the date the samples were actually tested (that is, the date the FOBT was done). Suppose the patient takes the FOBT cards home on May 5, and the physician's lab tests the samples on May 11. The correct service date is May 11.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C. and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.