Primary Care Coding Alert

Question: HCPCS 2009 shows Medicare deleted G0394 (Blood occult test [e.g., guaiac], feces, for single determination for colorectal neoplasm [e.g., patient was provided three cards or single triple card for consecutive collection]),effective Jan. 1, 2009. What code should I use instead?

Pennsylvania Subscriber

Answer: You should use CPT's diagnostic fecal occult blood test (FOBT) code: 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening). When your FP collects a specimen for other than colorectal neoplasm screening, for instance the patient complains of red-tinged stools (such as 792.1, -Nonspecific abnormal findings in other body substances; stool contents,- which includes abnormal stool color), 82272 would apply. The code's -1-3 simultaneous determinations- definition allows you to report 82272 for either a digital rectal exam (DRE) or a three-test card.

Do this for screening tests: If the physician reports V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; rectum), use 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]) for screening FOBT tests. As the code describes, make sure the test is for -consecutive collected specimens.- Medicare will cover a screening FOBT once per year if the beneficiary aged 50 or older takes home cards, obtains fecal samples, and returns the cards to the physician or laboratory (www.cms.hhs.gov/ColorectalCancerScreening/). Don't expect screening pay if the physician takes a single sample from a DRE.