Pathology/Lab Coding Alert

We'll show you how use Medicare's new iFOBT coding rules

Code G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) is no longer the only way to bill Medicare for screening fecal-occult blood tests (FOBT). Now Medicare also pays for the immunoassay test -- iFOBT-- using HCPCS G0328 (Fecal blood screening immunoassay). CMS' coverage decision could boost your bottom line -- the National Limitation Amount for iFOBT is $18.57, compared to $4.66 for the guaiac-based test.

"In the past, Medicare covered only guaiac-based FOBT to screen beneficiaries age 50 and older for colorectal cancer," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa. Medicare added iFOBT coverage Jan. 1, 2004.

"The immunoassay fecal-occult blood test appears to be both accurate and easy to use, but it is not yet covered by most payers," says Sean Tunis, MD, CMS' chief medical officer. "Medicare reimbursement for this test should lead to reduced morbidity and mortality for colorectal cancer."

Medicare anticipates that the new, patient-friendly iFOBT will encourage more beneficiaries to obtain screening for early detection of colorectal cancer, not simply displace current testing practices. So you should expect to continue billing G0107 for screening guaiac tests performed by your lab, and expect to add billing for G0328 for iFOBT colorectal cancer screening. See "3 Easy Steps Improve Your FOBT Coding"  to learn when to properly use this and other FOBT codes.