Pathology/Lab Coding Alert

Changes clear up card and DRE confusion

If you're puzzled about when and how to bill for a fecal occult blood test (FOBT) card sent home with the patient, you're not alone. Billing for each specimen on an FOBT card has always been a fraudulent practice, but the 2006 code changes help to clarify that point.

The clarification comes from CPT revising the existing 82270 for the take-home card, which uses multiple specimens, and adding 82272 for a single specimen that the physician collects as part of a digital rectal exam (DRE).

Select the Code by Method and Specimen

The new and revised CPT codes, along with existing codes for occult blood tests, are as follows:

• 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)

• 82271--...other sources

• 82272--Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g.,  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 or a guaiac-based hemoglobin test. The immunoassay test identifies the globulin portion of the molecule. On the other hand, the guaiac-based test 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, Ore.

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.

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 and submits it for an 82272 service, 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.

Keep Screening and Diagnostic FOBTs Straight

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.

If you get the codes wrong, you may receive unnecessary denials, Beaulieu says. Medicare pays for a screening FOBT once a year, but diagnostic FOBT every three months. 

Document necessity: If you bill a diagnostic FOBT, you must document a reason for it. If the patient has blood in the stool or is taking medications such as aspirin or non-steroidal anti-inflammatories that cause abdominal bleeding, she's entitled to a diagnostic FOBT,  Beaulieu says.

Because a physician orders a screening test in the absence of signs or symptoms of disease, you have to use diagnosis code V76.51 (Special screening for malignant neoplasms, colon) to indicate medical necessity for tests ordered as G0107 or G0328.