Pediatric Coding Alert

Question: A patient came in with abdominal pain, and the pediatrician checked for blood in the stool. The physician wants to know if he should include the hemocult testing in the E/M, or if we can separately bill for the test. If so, what CPT code should we use?

Answer: If office staff performs the test, which is granted waived status under the Clinical Laboratory Improvements Amendments (CLIA), and your office has a certificate of CLIA-waived status, you should code for the test using 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening). This code is for a diagnostic test, meaning the patient had a sign or symptom (such as 789.0, Abdominal pain). The code's "1-3 simultaneous determinations" definition allows you to report 82272 for either a digital rectal exam (DRE) or a three-test card.

-- Information for and answers to You Be the Coder and Reader Questions provided/reviewed by Quinten A. Buechner, MS, MDiv, CPC, ACS-FP/GI/ PEDS, PCS, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis.; Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville; and Jill Young, CPC, CPC-EDS, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich.