Internal Medicine Coding Alert

Published on Tue Jan 03, 2006 PDF

Question: The National Correct Coding Initiative edits state that I can bill both 82270 and 82272 on the same day. What modifier should I use?


New Jersey Subscriber

Answer: Although you are correct that the NCCI does allow a modifier to override the 82270 and 82272 edit pair, it is doubtful that circumstances will warrant billing both codes on the same date of service.

Remember: For fecal occult blood test (FOBT) claims in 2006, you should report the take-home test with 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]) and the in-office test with 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]). Usually, you would report the in-office test when the internist collects a sample during a digital rectal exam. The physician may then instruct the individual on the take-home test procedures and give him the cards for at-home collection.

But you should report the take-home test when the patient returns the cards, not when the physician orders the test. Some individuals may not return the cards, in which case you should not bill for the test. Therefore, you would code the FOBTs on different days.

For instance: On day 1, you should report the in-office test (82272), as well as any performed and documented significant and separately identifiable E/M service (such as 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient ...; significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). For the take-home test, assign 82270 on the day you receive the card samples.

Hypothetically, if a person returned with the cards on the same day that he had the exam and in-office FOBT, you could assign 82270 on the same date of service as 82272 and 9921x-25. In these cases, you should assign modifier 59 (Distinct procedural service) to 82272 to indicate the take-home test occurred at a separate session from the in-office test. But an individual would rarely return the cards on the same day as the in-office exam and test.

Reporting 82272 and 82270-59 would mean the patient would have to go home, collect three stool samples and return them to your office on the same day the internist ordered the in-office test.