Part B Insider (Multispecialty) Coding Alert

Double-check method--and specimen

Billing rules for fecal occult blood test (FOBT) have undergone some changes. Review the information below to ensure you are on the right track.

CPT revised the existing code 82270 for the take-home FOBT card, which uses multiple specimens, and added 82272 for a single specimen that the physician collects as part of a digital rectal exam (DRE). Here are the codes you should be using:

• 82270--Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces…
• 82271--…other sources
• 82272--Blood, occult, by peroxidast activity (e.g., guaic), qualitative, feces…from digital rectal exam
• 82274--Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations

To select the proper code from this list, first you have to know whether the lab uses an immunoassay test, which identifies the globulin portion of the molecule--or a guaiac-based hemoglobin test, which shows peroxidase activity in the heme moiety.

How it works: For the guaiac-based test, select 82270, 82271 or 82272. Use 82271 for any source other than feces. “For fecal specimens tested for peroxidase activity, you’ll have to choose between revised code 82270 and new code 82272,” says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, CEO of Chargemaster Maintenance Services, a laboratory consultation company in Portland, OR.

Use 82270 when the patient collects multiple consecutive specimens and sends the card to the lab for a single determination. When the physician collects a single fecal specimen from a DRE, report 82272. If the lab performs the immunoassay test, you should report the service as 82274.

Important: Although you should use 82270-82274 for diagnostic FOBTs, Medicare requires “G” codes when you perform the test for colon-cancer screening on asymptomatic patients. The screening codes are G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) and G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations) in HCPCS Level II 2005.

Avoid unnecessary denials by keeping these codes straight: Medicare pays for a screening FOBT only once a year, but diagnostic FOBT every three months.