Combat Confusion Surrounding the 2006 Digital Rectal Exam/FOBT Codes
Published on Mon Oct 02, 2006
The code creators explain the differences between 82270, 82272 and G0107
Coding for digital rectal exam-related testing has never been easy, but when CPT introduced new codes for these services in January, you may have heaved a sigh of relief.
Unfortunately, in some cases, these new codes generated more questions than answers. We went to the code creators to bring you the inside scoop on coding for fecal occult blood test (FOBT) and DRE tests.
The creation of a separate CPT code for analysis of feces collected during a DRE led many Family Practice Coding Alert readers to ask whether they could code a DRE for screening purposes and then send the patient home with the FOBT cards. At first, we said yes. But as it turns out, the answer is no.
Read on to get the lowdown on properly reporting the following codes:
- 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 three cards or single triple card for consecutive collection)
- 82272--Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g., from digital rectal exam)
- G0107--Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations. Reserve 82270, G0107 for Screenings The first point to keep in mind is that you should use 82270 or G0107 to describe screenings only, says Glenn Littenberg, MD, a member of the American College of Physicians subcommittee on coding and reimbursement, which developed the code change language. That means that 82270 and G0107 should always be linked to a screening V code, such as V76.41 (Special screening for malignant neoplasms; other sites; rectum) or V76.51 (Special screening for malignant neoplasms; intestine; colon).
Revised code 82270 now echoes G0107 in its reference to a set of three cards that the patient takes home. You should bill either FOBT code -on the date the tests are run on the cards, not when they are given to the patient to take home,- Littenberg says.
Report 82270 or G0107 based on the insurer. You should report a colorectal cancer screening FOBT to a private payer with 82270. Use G0107 for Medicare. CMS no longer accepts 82270 effective April 1, 2006. Describe Symptomatic Specimen Test With 82272 If a patient has a sign or symptom, stick with 82272. -We do not recommend DRE as part of colorectal cancer screening,- says Leonard Lichtenfeld, MD, FACP, deputy chief medical officer for the American Cancer Society. Possible indications for 82272 include:
- abdominal pain--789.00, Abdominal pain; unspecified site
- blood in stool--578.1
- dark stools--792.1, Nonspecific abnormal findings in other body substances; stool contents, such as -abnormal stool color.- Coverage update: Medicare did add 82272 to its list of accepted CPT codes, effective April 1, [...]
