Medicare Compliance & Reimbursement

Scratching your head over new mystery HCPCPS code? Here's what you need to know.

Just when you thought fecal occult blood test (FOBT) coding had gotten easier, Medicare threw a new code into the mix.

The Centers for Medicare & Medicaid Services (CMS) just deleted screening code G0107, which means you should only use CPT code 82270 for a screening FOBT. But then CMS introduced 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).

Confusion: Nobody's quite sure what you're supposed to use G0394 for. On the one hand, it's clearly not a screening code because it's not on the "screening list," says Melanie Witt, a coding expert based in Guadalupita, NM. On the other hand, it contains the reference to a "single determination" as well as to providing the patient with cards to obtain two or more samples.

So far, one carrier, Highmark Blue Shield, has weighed in on G0394 and instructed providers to use it for diagnostic FOBTs. That still doesn't explain how you can have a "single determination" as well as three cards, say coding experts.

Tip: You should keep using diagnostic code 82272 when your physician only collects one sample in the office and doesn't send the patient home with cards, says Jan Rasmussen, president of Professional Coding Solutions in Eau Claire, WI.

Rasmussen says one CMS official told her you could use G0394 if the patient is on "high-risk meds that cause GI bleeding." You would bill this code with a diagnosis of high-risk medication, she explains.

Bottom line: There are two situations where you might be able to use G0394, says Witt:

1) The patient comes in with a complaint including rectal bleeding. The doctor takes a sample in the office to confirm the diagnosis, then sends the patient home with cards to obtain more samples.

2) The patient took cards home to check for rectal bleeding, and as a result of that test, the doctor takes an additional sample in the office.