Gastroenterology Coding Alert

Question: How do we know whether to report a screening or diagnostic code for a fecal occult blood test (FOBT)?

Codify Subscriber

Answer: Take note of the ordering diagnosis, and you’ll know whether to use a diagnostic or screening code for FOBT. If the physician reports Z12.11 (Encounter for screening for malignant neoplasm of colon) or Z12.12 (Encounter for screening for malignant neoplasm of rectum), it means 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. For instance, the physician might indicate conditions such as unexpected anemia or patient complaint of red-tinged stools (R19.5, Other fecal abnormalities) as a diagnosis.

You would bill 82270 (Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [ie, 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.

The three-card rule: Medicare will cover a screening FOBT only when the patient takes home cards, obtains fecal samples, and returns the cards to the physician. 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.