Pathology/Lab Coding Alert

Watch out for FOBT G codes Whether a fecal specimen is from a digital rectal exam (DRE) or not, CPT 2008 makes one thing clear -- you should only use 82272 for diagnostic testing. Although the 82272 change aligns with Medicare rules and allows sampling-method flexibility for a diagnostic guaiac fecal occult blood test (FOBT), it raises even more questions about when to use G0394 -- a code that Medicare added just last year. Distinguish Diagnostic vs. Screening in CPT 2008 The new 82272 definition (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening) clarifies that you should only use this code for diagnostic tests, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M. Emphasis changed: The old 82272 definition (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) emphasized the specimen-collection method -- DRE. But the new definition emphasizes the reason for the test -- other than colorectal neoplasm screening. Don't miss: You can still use 82272 for DRE collections. According to CPT 2008 Changes: An Insider's View: "The inclusion of the phrasing -1-3- in the descriptor clarifies that 82272 is appropriately reported for assessment of either a single sample obtained from a digital rectal exam or for assessment of a three-test card prepared by the patient." Screening code is different: If your lab performs a screening guaiac-based FOBT, you should continue to report 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 3 cards or single triple card for consecutive collection]). Don't miss the screening specimen requirement: You should not use 82270 for a DRE specimen. The code definition makes this clear by specifying "consecutive collected specimens," and beginning the parenthetic phrase with "i.e.," which means "that is," -- not "e.g.," which means "for example." Here's the reason: Studies have shown that office-based, single-sample FOBT specimens have limited screening value. Solve the G0394 Mystery CMS added 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]) to the FOBT coding mix last year, and experts are still scratching their heads about how to use the code. "Code G0394 is clearly not a screening code because it's not on Medicare's screening list," Witt says. "But the definition is confusing because it refers to a -single determination- as well as -consecutive collection- cards." Now that CPT 2008 changed 82272 to include either DRE or multiple-card specimens, G0394 seems to be even more of an orphan code. CMS [...]