Internal Medicine Coding Alert

Question: An established patient receives a level-two E/M service from the internist, who then sends the patient home with sample cards for a "take-home" fecal occult blood test (FOBT) screening. What code best represents this FOBT?

Kansas Subscriber

Answer: When the internist conducts a take-home FOBT for screening purposes, code the service with 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]).

Remember: You should not report 82270 to the insurer until the patient returns the sample card(s). Once you get the sample card(s) back from the patient, report the following:

• 82270 for the FOBT

• 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) for the E/M

• modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99212 to show that the FOBT and E/M were separate services.

-- Answers to You Be the Coder and Reader Questions were reviewed by Bruce Rappoport, MD, CPC, CHCC, a board-certified internist and medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla.