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Gastroenterology Coding Alert

Review:

Choose the Correct FOBT Code

Published on Sat Apr 04, 2009

Now that you have one less code to worry about, here's how.

Here are the coding-decision basics when your office performs a peroxidase-activity fecal occult blood test (such as guaiac-based tests):

1. Diagnostic or screening: You'll know whether to use a diagnostic or screening code by the ordering diagnosis. If the physician reports V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; rectum),the lab is performing a screening.

If the physician orders the FOBT based on a known condition, disease sign or symptom, the lab is performing a diagnostic test. You might see the test ordered for conditions such as unexpected anemia (280.0-280.9, Iron deficiency anemias) or patient complaint of red-tinged stools (787.7, Abnormal feces),You can see a complete list of diagnostic FOBT "payable diagnosis" ICD-9 codes on the NCD Web site at www.cms.hhs.gov/CoverageGenInfo/downloads/manual200901.pdf#23.

2. If screening, use 82270: Use 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]) when your physician orders an FOBT and the patient has no prior sign of colon cancer.As the code describes, make sure the test is for three "consecutive collected specimens."

Before January, for patients with Medicare coverage you used G0394 (Blood occult test [e.g., guaiac], feces,for single determination for colorectal neoplasm screening [e.g., patient was provided three cards or single triple card for consecutive collection]), says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel. Because the CMS transmittal to remove G0394 was issued on Jan. 2, 2009, it is possible that some Medicare carriers may continue to issue payment using the G0394 code and some will deny it, Weinstein says. If you receive denials using G0394 code, you should resubmit the claim using 82270.

Must use three cards: Medicare will cover a screening FOBT only when the patient takes home cards, obtains fecal samples, and returns the cards to the physician. Don't expect screening-test payment if the physician takes a single sample from a digital rectal examination. If the patient fails to complete the three consecutive sample tests according to instructions, then re-explain the test and send the patient home with another three-sample test, Weinstein says.

Three cards, one code: Resist the temptation to bill separately for each card a patient uses. Insurers will pay for only one FOBT code, regardless of the number of samples involved.

Beware of frequency limits: For beneficiaries age 50 or older, Medicare will pay for only one colorectal cancer screening using a number of different screening methods according to frequency limitations, Weinstein says. Medicare allows payment for only one screening peroxidase-activity FOBT per year (82270), which is often combined with G0104 (Colorectal cancer screening; flexible sigmoidoscopy) performed every four years for effective colorectal cancer screening.Alternately, Medicare covers G0106 (Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy,barium enema).

3. Do this for diagnostic tests: If your office is not performing the FOBT for colorectal neoplams screening-- that is, you've got a diagnosed condition, sign, or symptom -- use 82272 for peroxidase FOBT tests. You should use this code regardless of specimen collection method. The code allows "1-3 simultaneous determinations," so you may use the code for a digital rectal exam specimen or for a three-test card.

Know the FOBT Immunoassay Codes

If your lab performs an FOBT by a method other than peroxidase activity, you can't use the codes for guaiac tests (82270 and 82272). Although the guaiac test is an effective method to detect lower bowel bleeding, meat consumption or bleeding associated with a procedure can interfere with results.

That might be one reason your gastroenterologist would order an immunoassay FOBT, which is less affected by diet.

Do this: To report the immunoassay, list 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations).

"For some payers, you can use 82274 for a screening or diagnostic FOBT immunoassay," Witt says.

Specimen collection doesn't matter: Like 82272,specimen collection doesn't matter for 82274. That means you can use the code for a single specimen collected from a DRE or from cards with up to three separate specimens.

Medicare screening is different: If you're reporting a screening FOBT immunoassay to Medicare, you can't use 82274. Instead, you should report G0328 (Colorectal cancer screening; fecal occult blood test,immunoassay, 1-3 simultaneous determinations).

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