Primary Care Coding Alert

Only 9 percent of eligible fee-for-service Medicare beneficiaries get their annual fecal occult blood testing (FOBT), according to a recent study by the U.S. General Accounting Office (GAO). Although the recent colorectal-cancer awareness campaign by Today show host Katie Couric may increase public demand for the services, the GAO study found that many physicians do not encourage their patients to get an annual FOBT because they believe the reimbursement rates are inadequate to cover their costs. In many instances, however, family physicians (FPs) should be able to boost their reimbursement income by billing Medicare for both the FOBT and an office visit (99201-99205, new patient, or 99211-99215, established patient).

Medicares coverage of various colorectal-cancer screenings was enacted with the Balanced Budget Act of 1997. Family physicians will be concerned primarily with Medicares provisions for screening FOBTs, which are covered at a frequency of once every 12 months for beneficiaries who have attained age 50.

Use the Proper HCPCS and ICD-9 Codes

The proper HCPCS codes need to be submitted to Medicare to report the FOBTs. Code G0107 (colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) should be used to report fecal occult blood tests done on asymptomatic patients, says Jim Stephenson, CPC, billing manager for Premium Medical Management Inc, a multispecialty physician group practice in Elyria, Ohio. Code 82270 (blood, occult; feces, 1-3 simultaneous determinations) is reserved for reporting the diagnostic evaluation of symptomatic patients to Medicare. Reimbursement for both codes is the same.

Although screening FOBTs are for asymptomatic patients, those services also must be reported with the proper ICD-9 diagnosis code, which may differ from state to state. In Ohio, for example, the local medical review policy lists the following approved ICD-9 codes for asymptomatic individuals:

V10.05 (personal history of malignant neoplasm; large intestine),
V10.06 (personal history of malignant neoplasm; rectum, rectosigmoid junction, and anus),
V12.72 (diseases of digestive system; colonic polyps) and
V76.41 (special screening for malignant neoplasms; rectum).

Connecticut, on the other hand, has stated that it will accept only two ICD-9 codes: V76.41 and V76.49 (special screening for malignant neoplasms; other).

Unfortunately, HCFA didnt really publish a list of covered diagnosis codes, says Glenn Littenberg, MD, FACP, a gastroenterologist in Pasadena, Calif., and a member of the American Medical Associations (AMA) CPT editorial panel. It will vary from carrier to carrier.

Other Coverage Issues

The fecal occult blood test screenings are covered at a frequency of once every 12 months, which means that at least 11 months have passed following the month in which the last covered screening FOBT was done, explains Littenberg. If a patient received a test in January 2000, the count starts with February 2000. The patient will be [...]