Pediatric Coding Alert

Question: We reported 82270 for a Guaiac test, but the insurer denied it and said it only applied to patients 50 years and older.  What should we report for a one-year-old who has a diagnosis of blood in stool and the pediatrician orders a guaiac test?

Answer: In this case, 82270 (Blood, occult, by peroxidase activity [eg, guaiac], qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [ie, patient was provided 3 cards or single triple card for consecutive collection]) was not the appropriate code. This code refers to screening, whereas 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening is for diagnostic, which is more appropriate in your case. 

You should link 82272 to an ICD-9 code representing a sign or symptom that the patient experienced As a reminder, you’ll r report 82272 when the physician collects a single specimen usually in the office setting after a digital rectal exam (DRE). The doctor may conduct the test due to signs or symptoms or in conjunction with a preventive medicine service.