Primary Care Coding Alert

CPT introduces 82272 for analysis of in-office single-specimen collection

Beginning Jan. 1, you should separately code in-office fecal occult blood test (FOBT) specimen collection from take-home tests--or you could risk receiving underpayments and possibly denials.

Old way: For the past year, you have had to lump post digital rectal exam (DRE) and consecutive specimen collection under one code: 82270.

New way: CPT 2006 revises 82270 and also creates a new FOBT code. For your 2006 claims, you should assign each type of collection a specific code:

- 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.
 
Step 1: Choose Between Screening and Diagnostic

If you know why the family physician obtained an FOBT specimen, you can determine which code you should use. Code 82272 describe diagnostic tests that the physician orders when a patient has a sign or symptom, says Linda Parks, MA, CPC, CMC, CMSCS, coding supervisor for Atlanta Gastroenterology Associates in Atlanta, a 22-physician practice

When the FP instead orders an FOBT for screening purposes, you should report either 82270 or G0107. The descriptor for 82270 now says, -for colorectal neoplasm screening.- Meanwhile, Medicare maintains G0107 for a screening FOBT, which is one of the Medicare preventive medicine benefits, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. The separate G code allows Medicare to administer this particular benefit without otherwise having to worry about the diagnosis code attached to 82270.

The Medicare Carriers Manual specifies a screening FOBT as -a guaiac-based test for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools.- Medicare will cover G0107 once every 12 months provided the patient:

1. takes the cards home
2. obtains the samples
3. returns them to the physician.

CMS pays G0107, as well as 82270 and 82272, using the Medicare clinical lab fee schedule. -The allowance will range from $3.80 to $4.54 for each one, depending on the Medicare locality,- Moore says. You can download the fee schedule at www.cms.hhs.gov/providers/pufdownload/clfdown.asp.

Step 2: Look at the Number of Tests

CPT 2005 required you to use one code for FOBTs, regardless of the number of tests. -Previously code 82270 failed to distinguish between a single specimen - FOBT that is primarily done in the office setting, e.g., after a digital rectal exam, and a three-specimen FOBT that the patient typically collects at home,- states the AMA in CPT Changes 2006: An Insider's View.

Strategy: To choose between the diagnostic FOBT codes (82270 and 82272), identify how many tests the FP or lab performs. For a three-specimen collection, assign 82270. Report a single-specimen collection with 82272.

The collection location and performer also clue you in to the correct FOBT code. For you to use 82270, the patient has -to take the test card home,- obtain the samples and return them to the physician, said J. Leonard Lichtenfeld, MD, the American College of Physicians CPT representative in his FOBT speech at the CPT 2006 Coding Symposium. The physician can't collect the specimens in the office.

You should instead assign 82272 -when the physician performs a digital rectal exam in the office and obtains a sample at that time,- Parks says.

Example: After an FP examines a patient who complains of diarrhea, he performs a DRE, which includes a stool sample that will be tested in the office. Because the physician orders the test for a symptom (787.91, Diarrhea NOS) that the patient has, you can assume the service is diagnostic. The collection occurs in the office and involves one specimen. Therefore, you should code in-house analysis of the specimen as 82272.

Step 3: Report 1 Unit of 82270

Rule: When you code analysis of a take-home FOBT, you should always assign 82270 with a -1- in the units field. Some coders incorrectly interpret 82270's descriptor of -one to three simultaneous determinations- to mean they should bill -each of the three determinations with one unit of CPT 82270  (82270 x 3),- says Diana W. Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal at DV & Associates Inc., in Salt Lake City. -The revised description more clearly reminds providers that the code identifies as many as three consecutive determinations,- she writes in the article -2006 Laboratory Coding Changes.-

Important: If the patient fails to collect all three samples, you can still report 82270. In this scenario, the laboratory should perform analysis of the one or two -collected specimens, report the results accordingly and record one unit of 82270,- according to CPT Changes 2006: An Insider's View.