Pathology/Lab Coding Alert

Question: We’re receiving denials for three-card fecal hemoccult screening tests that we send home with patients. What could be the problem?

Tennessee Subscriber

Answer: Several things could cause denials for these fecal occult blood tests (FOBT), depending on the payer, such as the wrong diagnosis code, the wrong procedure code, or frequency limitations.

Generally, you should be using the one of two diagnosis codes for the screening test:

• V76.51 — Special screening for malignant neoplasms; colon
  
• V76.41 — Special screening for malignant neoplasms; rectum.
  

Assuming the lab performs the guaiac test, you need to make sure you’re reporting the procedure code for the three-card screening test (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]).

You might be getting denials if you’re using the code for a non-screening test for a specimen taken during a digital rectal exam (82272, Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening).

Watch frequency: Many payers limit how often they’ll pay for an FOBT screening. For instance, for beneficiaries aged 50 or older, Medicare will pay for one covered screening FOBT per year.