Primary Care Coding Alert

Question: Does Medicare cover fecal-occult stool samples for Medicare patients who are NOT at high risk (personal history of cancer), and, if so, what CPT and ICD-9 codes should I use to get it paid? Alabama Subscriber Answer: Fecal-occult blood testing has raised many questions for family practice coders. Many of the questions have to do with the inconsistent local medical review policies (LMRPs) for 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations) and the confusion around Medicare's coverage for screening fecal-occult blood testing.

Code 82270 is for diagnostic testing of patients who have symptoms consistent with suspected GI bleeding. The LMRPs, however, are not consistent with regards to which diagnoses are covered and which are not. Due to this inconsistency, this code was addressed as a part of the National Coverage Determinations for laboratory tests. These coverage decisions standardize covered and noncovered diagnoses across the country and went into effect Nov. 25, 2002, but will not be implemented until January 2003 to allow carriers to bring their LMRPs into line. This also allows the carriers to be sure their computer edits are compliant with the new requirements of the National Determination. Note: To view the National Determination policy, go to http://cms.hhs.gov/coverage/#lab. Medicare beneficiaries who have no symptoms, whether or not they are at high risk for colon cancer, are still encouraged by Medicare to have screening fecal-occult blood testing annually. If they obtain from their physician fecal-occult blood cards, take them home, obtain samples as directed on the cards, and return these cards to the physician's office for evaluation, Medicare will pay for this service for any beneficiary over the age of 50, once every 12 months. The service should be billed with HCPCS code G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations). Use ICD-9 code V76.51 (Special screening for malignant neoplasms; colon). Answered by Susan Welsh, CPC, PMCI, director of coding and education for HCA Physician Services in Nashville, Tenn.