Pathology/Lab Coding Alert

Here's why you should drop the G code

Medicare released a memo recently that promises the deletion of screening fecal-occult blood test (FOBT) code G0107 on Jan. 1, 2007. Here's how to prepare for this change now.

Brush Up on Screening FOBT Basics

What it is: The Medicare Claims Processing Manual specifies one type of screening 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:

1. takes the cards home

2. obtains the samples

3. returns them to the physician.

Now: When the physician orders an FOBT for screening purposes for a Medicare patient, you should report G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations).

In the future: Medicare will delete G0107 as of Jan. 1. To report a screening FOBT for a Medicare patient after that date, you will 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]).

-The change is a good thing for coders,- says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. -Now we-re all on the same page with one CPT code for screening.-

Watch Out for These Common Mistakes

Some coders incorrectly interpret 82270's descriptor of -one to three simultaneous determinations- to mean they should bill each of the three determinations with one unit of 82270 (82270 x 3). You should report 82270 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) 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 theFOBT test if the physician bills 82270 when he issues the card and the patient doesn't return the specimens.

Diagnostic Guaiac Test Is Different

For a diagnostic FOBT that the physician orders because of a sign or symptom of disease, report the test to Medicare using 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]).

Recent change: Until April 1, 2006, you could report a diagnostic guaiac-based FOBT to Medicare using 82270. That's when CMS enacted a change to the laboratory National Coverage Determination (NCD) for diagnostic FOBT stating that you should no longer use 82270 but should instead use 82272.

Why? A single sample collected by digital rectal exam isn't clinically useful for screening purposes. Chances are if a physician collects a single specimen, it's a diagnostic test. That's why if the patient has a particular symptom such as rectal bleeding (569.3, Hemorrhage of rectum and anus), you should use 82272, says Deb Arneson, CPC, with the Kernodle Clinic in Burlington, N.C.

Do this: That logic aligns with Medicare's FOBT rules following the April 1, 2006, and the Jan. 1, 2007, rule changes -- use 82270 for screening guaiac FOBT and 82272 for diagnostic guaiac FOBT.

Document necessity: If you bill a diagnostic FOBT, you must document a reason for it. For instance, if the patient is taking medications such as aspirin (V58.66, Long-term [current] use of aspirin) that can cause abdominal bleeding, the physician may order a diagnostic FOBT, Beaulieu says.

Note frequency: For a diagnostic FOBT, Medicare will cover the test once every three months instead of once every 12 months for a screening test.