Pathology/Lab Coding Alert

Don't limit Medicare screening to G codes

Before recent Medicare changes, you could remember the rule of thumb--G codes for screening FOBTs, and CPT codes for diagnostic FOBTs. But that's not true any more.

What it is: The Medicare Claims Processing Manual specifies one type of screening fecal-occult blood test (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 a screening FOBT once every 12 months if the patient does the following:

1. takes the cards home
2. obtains the samples
3. returns them to the physician.

To report a screening guaiac FOBT for a Medicare patient, use 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]).

Use Different Code for Immunoassay
 
 When the lab performs an immunoassay method for a screening FOBT, you shouldn't use 82270. Instead, report G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations) for Medicare patients. For most other payers, you should use the same code that you use for the diagnostic immuno-assay--82274, Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations.

Watch Out for These Common Mistakes

You might be tempted to interpret the code descriptor of -one to three simultaneous determinations- to mean they should separately bill each of the three determinations. But that is not correct--you should report the proper code (82270, G0328 or 82274) only once.

Pitfall: Failure to show medical necessity for a screening FOBT is another common error. Because a physician orders the screening test in the absence of signs or symptoms of disease, you have to use a diagnosis code such as V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; other sites; rectum) to indicate medical necessity for a screening FOBT.

Get the Date of Service Right

The date of service for lab tests is the date of specimen collection. Although the date is clear when the physician takes the specimen during a patient encounter, what date should you use when the physician sends the patient home with a card?

For 82270, the lab should use the date it receives the card as the date of service. Many coders become confused about the date of service for FOBT codes, says Donna Beaulieu, consultant with Quality Physician Services in Stockbridge, Ga. But Medicare does not want you to use the date that the physician sends the patient home with the card.

Don't miss: You risk having to repay Medicare for the FOBT test if the physician bills 82270 when he issues the card and the patient doesn't return the specimens.