Gastroenterology Coding Alert
Say Goodbye to G0394 and Still Get Your FOBT Test Payment
Don't be fooled: 1 fewer occult blood code actually makes coding clearer. A guaiac-based FOBT finds hidden blood by placing a small sample of stool on a chemically treated card, pad, or cloth wipe. Then a chemical solution is put on top of the sample. If the card, pad, or cloth turns blue (which demonstrates peroxidase activity),there is blood in the sample. That doesn't necessarily mean the patient has colon cancer, but it does mean that the patient needs further examination. Stop Using G0394 After three years of confusion about how to code screening versus diagnostic FOBTs, CMS removes questions by erasing a code. The code in question is G0394 (Blood occult test [e.g., guaiac], feces, for single determination for colorectal neoplasm [e.g., patient was provided three cards or single triple card for consecutive collection]), which was introduced in 2006. HCPCS 2009 deletes G0394. And in an emergency update to the 2009 Medicare Physician Fee Schedule (MPFS) dated Jan. 2, CMS directed contractors to "manually enddate code G0394 effective Dec. 31, 2008," and "manually remove code G0394 from the 2009 [MPFS] file." Regardless of how you've used this code in the past -- whether for screening or diagnostic FOBT, depending on your payer's direction -- you should no longer be reporting G0394 as of Jan. 1, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based in Guadalupita, N.M. Wait Till Patient Brings Cards Back Some offices make the mistake of billing for an FOBT when the cards are given to the patient. Yet no testing has actually taken place, so insurers will not pay. Wait until the patient brings back the cards and you have a result. "If the patient does not come back with a specimen,what service have you provided?" asks Susan Williams CPC, CGCS, coder at Austin Gastroenterology PA in Texas. Get the right date: 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 results were noted). 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. What About CLIA? CMS granted "CLIA-waived" status to both tests described by codes 82270 and 82272 -- that is, your office does not have to comply with the Clinical Laboratory Improvement Amendments to process FOBT cards. Your office still needs to register with CLIA and obtain a CLIA certificate indicating you only perform "CLIA-waived" tests. And you can forget about the modifier; according to CMS, you do not need to append modifier QW (CLIAwaived test) to either of these codes. What's the Next Coding Step? When your gastroenterologist performs an endoscopy on the basis of a positive FOBT result, support the procedure with 578.1 (Blood in stool) and 792.1 (Nonspecific abnormal findings in other body substances;stool contents). This is for occult, or hidden, blood in the stool that the FOBT discovered. Most Medicare carriers accept 578.1 with 792.1 as diagnoses to support a colonoscopy (45378, Colonoscopy,flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing,with or without colon decompression [separate procedure]). Be aware: Some carriers deny rectal bleeding 569.3 (Hemorrhage of rectum and anus) as a justification for a colonoscopy because they presume that the source of the bleeding is the rectum or anus, not the colon. They do accept rectal bleeding, however, as an acceptable diagnosis for a flexible sigmoidoscopy (45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).
Gastroenterology Coding Alert
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