Internal Medicine Coding Alert

Question: HCPCS 2009 shows Medicare deleted 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]),effective Jan. 1, 2009. What code should I use instead?

Pennsylvania Subscriber

Answer: You should use CPTs diagnostic fecal occult blood test (FOBT) code: 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]) for colorectal cancer screening.

When your physician collects a specimen for other than colorectal neoplasm screening -- for instance, the patient complains of red-tinged stools (such as 792.1,Nonspecific abnormal findings in other body substances; stool contents, which includes abnormal stool color) -- 82272 (Blood, occult, by peroxidase activity [e.g., guaiac],qualitative, feces, 1-3 simultaneous determinations,performed for other than colorectal neoplasm screening) would apply. The codes 1-3 simultaneous determinations definition allows you to report 82272 for either a digital rectal exam (DRE) or a three-test card.

Do this for screening tests: If your physician reports V76.51 (Special screening for malignant neoplasms;colon) or V76.41 (Special screening for malignant neoplasms; rectum), use 82270 for screening FOBT tests.

As the code describes, make sure the test is for consecutive collected specimens. Medicare will cover a screening FOBT once per year if the beneficiary aged 50 or older takes home cards, obtains fecal samples, and returns the cards to the physician or laboratory (www.cms.hhs.gov/ColorectalCancerScreening/).