Pathology/Lab Coding Alert

Question: Which codes does Medicare cover for the screening fecal-occult blood test?


Colorado Subscriber

Answer: Medicare pays for a screening fecal-occult blood test (FOBT) with one of two procedure codes: G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) or G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations). Use G0107 for a guaiac-based test, and use G0328 for the immunoassay method.

Although using the HCPCS level II G code indicates that this is a screening test, you must also use the proper ICD-9 code for screening. You need to use a diagnosis code indicating that the physician orders the FOBT in the absence of signs or symptoms of disease - which means it is for a screening.

For a screening FOBT test for a Medicare patient, the physician should select an appropriate ICD-9 code such as V76.41 (Special screening for malignant neoplasms; other sites; rectum) or V76.51 (Special screening for malignant neoplasms; intestine; colon).

If the patient has symptoms such as diarrhea (787.91, Diarrhea NOS), or a known condition such as irritable bowel syndrome (564.1, Functional digestive disorders, not elsewhere classified; irritable bowel syndrome), report these  ICD-9 codes as the reason for the test. In such cases, Medicare considers the FOBT diagnostic rather than screening, and you should report the test itself with the appropriate CPT code, such as 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations).

Limitation: Medicare covers screening FOBT only once every year for beneficiaries aged 50 years and older.