Internal Medicine Coding Alert

Published on Mon May 11, 2009 PDF

This simple switch halts deleted code denials.

If denials for G0394 plague you, plug this revenue loss with the lowdown on reporting FOBT tests.

Remove G0394 FromYour Superbill

In 2009, CMS 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]). Code G0394 was not a screening code because it was not on Medicares screening list. But the definition is confusing because it refers to a single determination as well as consecutive collection cards.Medicare payers showed no consistency regarding the code. For instance, some Aetna,Oxford, and Blue Cross/Blue Shield plans listed G0394 for colorectal cancer screening, while others such as Empire, Noridian, and TrailBlazer listed G0394 for diagnostic FOBT.

Turn to 82272 for Diagnostic Test

If a single occult (guaiac) card test is performed for reasons other than colorectal neoplasm screening, then use 82272 (Blood, occult, by peroxidase activity [e.g.,guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening).

How come? Code 82272 was revised to clarify that it is intended to describe testing for occult blood by peroxidase activity including from one to three simultaneous determinations. Code 82272 has further been revised to clarify that it is performed for other than colorectal neoplasm screenings, to differentiate this test from 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 3 cards or single triple card for consecutive collection]). The 2008 82272 definition clarified that you should only use this code for diagnostic tests, says Jay Neal, a coding consultant in Atlanta

Code 82272s revision clarifies the intent of this code as a diagnostic test appropriately reported for use of a three-test card ordered for symptomatic reasons.The 82272 definition clarifies that you should use this code only for diagnostic tests, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M.

Rely on 82270 asYour Screening Code

Fecal occult blood testing (FOBT) is the most widely prescribed screening test for colorectal cancer (CRC) because it is simple, non-invasive, and it has been demonstrated that it reduces the mortality due to colorectal carcinomas (CRC), say physicians reporting in a 2008 issue of the journal Clinical Laboratory. The authors go on to state that guaiac-based FOBTs suffer from poor sensitivity, particularly with respect to detecting early stages, as well as low acceptance among the population.

For an FOBT screening, use 82270.