Pathology/Lab Coding Alert

Coding for fecal occult blood tests (FOBT) involves understanding the various tests and time frames described by the codes. Laboratories also need to be aware of the indications for FOBT for diagnostic and screening purposes. Without this knowledge, laboratories may not be reimbursed for these tests.

The purpose of an FOBT is to determine if the patient has blood in the stool, says Joy Richardson, MT (ASCP), medical technologist at Norton Healthcare in Louisville, Ky. The test is sometimes carried out in the physicians office when a fecal specimen is acquired during a digital rectal examination. Then the stool sample is treated with a reagent and examined for a color reaction that will indicate if blood is present, Richardson says.

More commonly, the patient collects the specimens at home. The physician sends the patient home with a test kit that includes three cards. The test instructions say to smear a small portion of stool on one card and repeat the procedure on separate days for the other two cards. When all the specimens are collected, the patient sends the cards to the laboratory for simultaneous occult blood determination using the same test method described above.

Despite the fact that the test in the office involves one specimen and the take-home test involves three, the same code (CPT 82270 , blood, occult; feces, 1-3 simultaneous determinations) describes both services. The CPT language clarifies this usage, says Collette Shrader, compliance and reimbursement educator at Wenatchee Valley Clinic, representing 160 providers and seven locations in central Washington.

Deciding Which Test to Use

There are various test kits and methods available to identify hidden blood in the stool, says Richardson. The type we use is a guaiac-based test, she continues. This test is the most sensitive for detecting lower-bowel bleeding and is the basis of most FOBT kits.

Many kits are approved for use in labs with waived status under the clinical laboratory improvements amendment (CLIA) certification. CLIA waived-status laboratories should report test code 82270 with the -QW (CLIA waived test) modifier for Medicare reimbursement.

Other methods include a hemoglobin immunoassay that is less affected by diet and a heme-porphyrin assay that is valuable for evaluating overall gastrointestinal bleeding. Although these tests are less common and involve different laboratory methods, also report them with 82270.

Diagnostic vs Screening Tests

Many medical conditions indicate reasons for conducting an FOBT. To code correctly, however, you must know whether the test is ordered for diagnostic or screening purposes, explains Shrader.

1. How do we code for screening tests? Medicare has approved the guaiac FOBT as a screening tool for colorectal cancer. According to the Health Care Financing Administration (HCFA) program memorandum AB-97-24, a screening FOBT [...]