Hint: Use 82272 for analysis of in-office single-specimen collection Beginning Jan. 1, you should separately code in-office fecal occult blood test (FOBT) specimen collection from take-home tests -- or you could risk receiving underpayments and possibly denials.
Old way: For the past year, you have had to combine digital rectal exam (DRE) and consecutive specimen collection under one code: 82270.
New way: CPT 2006 revises 82270 and also creates a new FOBT code. For your 2006 claims, you should assign each type of collection a specific 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 three cards or single triple card for consecutive collection)
- 82272 -- Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g., from digital rectal exam)
- G0107 -- Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations. Step 1: Choose Between Screening and Diagnostic If you know why the ob-gyn obtained an FOBT specimen, you can determine which code you should use. Code 82272 describes a diagnostic test that the physician performs when a patient has a sign or symptom.
When the ob-gyn instead orders an FOBT for screening purposes, you should report either 82270 or G0107. The descriptor for 82270 now says, -for colorectal neoplasm screening.- Meanwhile, Medicare maintains G0107 for a screening FOBT, which is one of the Medicare preventive medicine benefits, says Kent J. Moore, manager of Health Care Financing and Delivery Systems in Leawood, Kan. The separate G code allows Medicare to administer this particular benefit without otherwise having to worry about the diagnosis code attached to 82270. The Medicare Carriers Manual specifies a screening FOBT as -a guaiac-based test for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools.- Medicare will cover G0107 once every 12 months if the patient:
1. takes the cards home
2. obtains the samples
3. returns them to the physician, says Sue Morrison, CCS-P, ob-gyn coding specialist at Sparta Community Hospital in Illinois.
CMS pays G0107, as well as 82270 and 82272, using the Medicare clinical lab fee schedule. -The allowance will range from $3.80 to $4.54 for each one, depending on the Medicare locality,- Moore says. You can download the fee schedule at
www.cms.hhs.gov/providers/pufdownload/clfdown.asp. Step 2: Look at the Number of Tests CPT 2005 required you to use one code for FOBTs, regardless of the number of tests. -Previously, code 82270 failed to distinguish between a single-specimen - FOBT that is primarily done in the office setting, e.g., at the time of a digital rectal exam, and a three-specimen FOBT that the patient typically collects at home,- states the AMA in [...]
