Increase Reimbursement by Properly Coding FOBTs
Published on Wed Sep 01, 1999
If youre not billing payers for fecal occult blood tests (FOBTs) performed during an office visit, you could be throwing reimbursement dollars away. Practicing gastroenterologists and their coders can bill code 82270 (blood, occult; feces, 1-3 simultaneous determinations) for FOBT, also known as guaiac tests, separately from an evaluation and management (E/M) charge, and should be doing so, according to coding experts.
Although payers rules on FOBTs can differ, Glenn D. Littenberg, MD, a gastroenterologist in Pasadena, CA, and member of the American College of Physicians-American Society of Internal Medicines Committee on Payment and Coding, urges physicians to abandon traditions of bundling this test with E/M services because it is a lab test that has a designated code. And, he says, if a payer maintains that it is bundled, thats a decision that should be challenged. We have heard of GI practices that just dont bother to charge for FOBTs when they perform an E/M service (i.e., 99201-99205 or 99211-99215). So, does that mean you should never charge for other tests, such as a urinalysis or blood sugar? Where do you draw the line? he asks.
Littenberg says FOBTs are no different than any other tests performed by the physician during an office visit, and should be billed accordingly. It may be some coders habit to bundle the test, but since it has a code assigned to it, that certainly isnt the meaning of CPT, he insists.
Lost Revenue Adds Up
Although the reimbursement per test is low, typically $3 to $7 depending on the payer, Littenberg observes that those payments can add up, especially if your practice performs a lot of screening and diagnostic FOBTs. In his five-physician gastroenterologist practice, for example, Littenberg estimates that billing for FOBTs generates about $2,000 a year, assuming Medicare-equivalent reimbursement. We do a high volume of these tests, so small amounts turn into real dollars after a while. It can be a significant amount of money, depending on what your payer mix is, as there are some carriers who pay more than Medicare rates, he adds.
But Garnet Dunston, CPC, MPC, president of Dunston Enterprises Inc., a healthcare consulting company in Phoenix, AZ, says she has never seen an FOBT coded separately from an E/M service when the test is performed as part of an office visit. The former national secretary of the American Academy of Professional Coders says the only time she recommends the use of code 82270 is when the patient is given the set of three stool sample cards to take home. The CPT language stating one to three simultaneous determinations indicates the code should be used with the take-home sampling method, not the in-office test performed by the doctor [...]
