Pathology/Lab Coding Alert

Question: A physician sends a single fecal specimen from a DRE to the lab and orders "colorectal cancer screening." We perform a guaiac-based FOBT. How should we code this scenario?

Texas Subscriber

Answer: You shouldn't report a fecal occult blood test (FOBT) as a screening test for colorectal cancer if you have only a single specimen from a digital rectal exam (DRE). You'll need to determine if the physician noted signs or symptoms that prompted a diagnostic test for fecal blood.

CPT provides the following two codes for guaiac-based FOBT based on whether the test is for screening or diagnostic purposes:

• 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)
• 82272 -- ... 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening.

You can see that 82270 is for colorectal cancer screening, but it requires "consecutive collected specimens," which you don't have with a single specimen from a DRE. On the other hand, 82272 is for "other than colorectal cancer screening" but allows for "1-3 simultaneous determinations," which would describe a DRE specimen.

Do this: Determine if the physician noted signs or symptoms, such as patient-reported black stools (792.1, Nonspecific abnormal findings in stool contents, includes abnormal stool color). If so, you should report the symptom as the reason for the test, and use 82272.

On the other hand: When the physician gives the patient a FOBT test card for multiple stool collections (usually three) and orders a screening test in the absence of signs or symptoms, you should report 82270 with diagnosis code V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; rectum).