Pathology/Lab Coding Alert

Question: We received an order for a fecal specimen collected during a DRE for a patient with abdominal pain and dark stools. How should we code the case?

Texas Subscriber

Answer: For the diagnosis, you should report R10.9 (Unspecified abdominal pain). If the physician states that the condition is acute, you might use R10.0 (Acute abdomen) instead. Don’t report the screening code for fecal occult blood test (FOBT) (Z12.1, Encounter for screening for malignant neoplasm of intestinal tract), because the physician orders the test based on signs and symptoms of disease.

For the test itself, you should report 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening) if the lab method is peroxidase activity. As with the diagnosis code selection, you should avoid the screening procedure code in this case (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]).

Option: If the lab uses the immunoassay test for fecal occult blood, you should report 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations) instead of 82272.