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Distinguish Between Screening and Diagnostic Fecal Occult Blood Testing

Fecal occult blood testing (FOBT) detects the presence of trace amounts of blood in stool. Most payers will cover this service, but keep in mind there is a distinction between screening and diagnostic FOBT.
Only two tests qualify as screenings: The first of these is the guaiac test (82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [ie, patient was provided 3 cards or single triple card for consecutive collection]). For this test, the patient is given cards and collects the specimen. You will report 82270 when the patient returns the cards.
The second type of screening FOBT is the immunoassay test. This test is reported differently for private and Medicare payers. For payers who follow CPT® guidelines, report 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations.
Per Medicare National Coverage Determination (NCD) rules for Medicare beneficiaries, “When testing is done for the purpose of screening for colorectal cancer in the absence of signs, symptoms, conditions, or complaints associated with gastrointestinal blood loss,” you should report G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous determinations (immunoassay-based, fecal-occult blood tests).
Medicare will allow either one covered guaiac-based or one covered immunoassay-based screening FOBT (but not both) during a 12-month period for beneficiaries age 50 or older. Screening FOBTs are also covered for Medicare beneficiaries residing at skilled nursing facilities.
The FOBT is reported once for the testing of up to three separate specimens (comprising either one or two tests, per specimen). Medicare requires that the patient—not the physician—must collect the sample.
The immunoassay is a Clinical Laboratory Improvement Amendments (CLIA) waved test, and should be reported with modifier QW CLIA waived test appended. For payers who follow CPT® rules, report 82274-QW; for Medicare payers, report G0328-QW.
If a patient presents to the office with symptoms, report a diagnostic (rather than a screening) FOBT with 82272 Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening.

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2 Responses to “Distinguish Between Screening and Diagnostic Fecal Occult Blood Testing”

  1. Vera Perez says:

    I would like to confirm billing compliance for 82272…I understand when billing 82270 (screening) there must be 3 determinations before billing 82270. Must there be 3 determinations for 82272 before it can be billed. I understand 82272 can include up to 3 determinations. May we bill when only one determination is available (only one specimen is supplied)?

  2. bruce z says:

    Confused. We do immunoassay in my office. So if do rectal exam in office can not use stool for G0328 as yearly screen? Has to be collected by patient?
    Also if patient comes in with abd pain or anemia and check stool via rectal and immunoassay, should you bill 82274???