Gastroenterology Coding Alert

Question: A commercially insured patient with a recent episode of rectal bleeding reports to the gastroenterologist. The physician obtained a single fecal specimen via digital rectal examination (DRE) to see if the patient has evidence of persistent bleeding. The gastroenterologist sent the patient home. Which testing code should I choose: 82270 or 82272?

Kentucky Subscriber

Answer: Because your physician performed the fecal occult blood test (FOBT) due to the patient's symptoms, you'll report 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening).

If prompted by specific symptoms, the gastroenterologist often performs DRE testing in the office to see if the bleeding is ongoing. On the claim, remember to append 569.3 (Hemorrhage of rectum and anus) to 82272 to reflect the patient's bleeding.

"Take-home" FOBT code: While you'll report 82272 for in-office FOBTs, you should choose 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]) for a "take-home" FOBT.

During a take-home FOBT, the patient obtains the samples himself at home and returns the cards to the physician. Gastroenterologists conduct the 82272 FOBTs for screening purposes.

-- 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.