Coding Consult

June 2, 2006

Fecal occult blood tests

Before this year, you had to lump post digital rectal exams and consecutive specimen collection under one code: 82270. CPT 2006 revised 82270 and also created a new FOBT code: 82272. The G code, G0107, is unchanged. We'll explain how to decide which code is appropriate, but, first, here are descriptions of the three FOBT codes:

Consider the test's purpose

For example, a patient presents with abdominal pain and dark stools. You collect a sample during a digital rectal exam. "You should report the stool analysis with 82272," Rappoport says. The service is diagnostic because you ordered the test due to the patient's symptom (789.00, abdominal pain, unspecified site).

But when you order a FOBT for screening purposes, you should report either 82270 or G0107 (if it's a Medicare patient). The new descriptor for 82270 now says "for colorectal neoplasm screening." Because the test that 82272 describes isn't an adequate screening tool, you offer an at-home, three-sample FOBT. But for the take-home test, you have to wait to submit the 82270 or G0107 code until the day you receive the card samples.

Look at the test's details

Knowing whether the FOBT is a screening or diagnostic test won't necessarily tell you the correct code. You also may need to look at certain details, such as the number of specimens. This step was unnecessary last year. Before, you were required to use one code for FOBTs, regardless of the number of tests. Code 82270 failed to distinguish between a single-specimen FOBT that's primarily done in the office setting (after a digital rectal exam) and a three-specimen FOBT that the patient typically collects at home.

Now, to choose between 82272 and 82270/G0107, identify how many tests you or the lab performs. For a three-specimen collection, use 82270 or G0107. Report a single-specimen collection with 82272.

Although 82270 involves analysis of three specimens, you should always assign 82270 with a "1" in the units field. Don't interpret 82270's descriptor of "one to three simultaneous determinations" to mean you should bill each of the three determinations with its own unit of CPT 82270 (meaning that you'd bill three times), says Diana W. Voorhees, a coding and billing consultant at DV & Associates in Salt Lake City. "The revised description more clearly reminds providers that the code identifies as many as three consecutive determinations."

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.