Primary Care Coding Alert

Location of FOBT is critical to correct coding

When a patient reports to your FP for a fecal occult blood test (FOBT), knowing why and how the physician tested the individual are indispensable pieces of coding information.
 
Why? There are many different types of patients who might report to the FP for guaiac-based FOBT -- the patient may or may not have symptoms, and the test could be diagnostic or for screening purposes. Further, the FP can conduct one of two FOBTs, depending on the situation.
 
As a result, you-ll need to carefully read the documentation to determine the correct coding for FOBT before filing your claim. Reporting the wrong type of FOBT will likely result in a denial and some carriers- red flags for your practice.
 
If Patient Has Symptoms, Report 82272
 
When your FP performs an FOBT prompted by a patient's symptom(s), you-ll typically report 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) for the service.
 
-You-ll use 82272 when the patient already has a problem, such as a complaint of rectal bleeding. The physician will conduct the test to see if there is currently any bleeding,- says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. The FP collects the specimen as part of a digital rectal exam (DRE) in the office.
 
Check out these indicators that might warrant diagnostic FOBT testing from Medicare's National Coverage Determination (NCD):

 - To evaluate known or suspected alimentary tract conditions that might cause bleeding into the intestinal tract.

 -  To evaluate unexpected anemia.

 -  To evaluate abnormal signs, symptoms or complaints that might be associated with blood loss.

 -  To evaluate patient complaints of black- or red-tinged stools.

Another way to identify 82272 is the number of specimens the physician collects. For 82272 claims, the physician will collect one fecal specimen from the patient while he is in the office.
 
Example: A patient complaining of rectal bleeding reports to the FP. The physician performs a DRE, collecting one fecal specimen. The physician's office then performs an FOBT on the specimen. 
 
In this scenario, the FP collected a single in-office specimen during a DRE. On the claim, you should report 82272 for the FOBT.
 
Also, attach 569.3 (Hemorrhage of rectum and anus) to 82272 to reflect the patient's bleeding.
 
Make Sure Patient Takes Test Home for 82270
 
Although in-office FOBTs have their own code, you-ll use different codes to report the -take-home- FOBT, Witt says. During a take-home test (which the FP orders for screening purposes), the patient brings the cards home, obtains the samples himself and returns them to the physician, she says.
 
When the FP orders a take-home FOBT test, you should report 82270 for the FOBT once the patient returns the sample cards to the office and the FOBT is performed on the samples, says Susan Pincus, CPC, CHC, an independent coding consultant in West Palm Beach, Fla.
 
Example: A 60-year-old patient reports to the FP for a follow-up visit concerning his high blood pressure and diabetes. The physician talks to the patient about the importance of getting a colorectal cancer screening to check for any abnormalities. The physician sends the patient home with a kit containing three FOBT cards and instructions for specimen collection and return. The patient collects three samples and returns them to the FP.
 
In this scenario, you should report 82270 for the FOBT, using the date the patient returns the card as the date of service. Even if the patient is not able to supply the FP with three samples, you can still report 82270.    According to the AMA's CPT Changes 2006: An Insider's View, when the patient returns only one or two samples, -report the results accordingly and record one unit of 82270.-
 
Remember: Forget About G0107

Prior to 2007, coders reported 82270 for private-payer screenings, and G0107 (Colorectal cancer screening; fecal occult blood test, 1-3 simultaneous determinations) for Medicare carriers.
But CPT revised 82270 last year to -specifically state that the patient must be given the FOBT cards, just as Medicare requires,- Witt says.
 
Therefore, starting Jan. 1, 2007, Medicare deleted G0107 and instructed coders to report these FOBTs with 82270 (Medlearn Matters article MM5292).

Medicare, however, will still cover the 82270 test once every 12 months for its beneficiaries.

Use G0328 for Some Medicare FOBTs

As an alternative to the standard take-home FOBT, the FP might conduct an immunoassay FOBT. The immunoassay screening involves using a spatula or a special brush to collect the appropriate number of samples.
 
For Medicare patients older than 50 years of age, report G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations) for the screening when the physician performs an immunoassay FOBT.
 
Medicare will pay for an FOBT screening once every 12 months. To report the G0328 screening, you must have a written order from the beneficiary's attending physician. Medicare defines -attending physician- as a doctor of medicine or osteopathy who is fully knowledgeable about the beneficiary's medical condition and who would be responsible for using the results of any examination performed in the overall management of the beneficiary's specific medical problem. This could be the patient's FP. 
 
For optimal FOBT claims, always make sure you have the proper date of service in the documentation. Your best bet is to use the date the samples were actually tested (that is, the date the FOBT was done).
 
Suppose the patient takes the cards home on May 5, and the physician's lab tests the samples on May 11. The correct service date is May 11.
 
Urine Check for Occult Blood? Coding Will Change
 
Sometimes the FP may have to analyze another substance for blood, such as a patient's nipple discharge or urine. When the FP chooses to analyze one of these substances for occult blood, report 82271 (- other sources) rather than 82270, Witt says.