Part B Insider (Multispecialty) Coding Alert

Published on Sun Apr 09, 2006 PDF

Medicare won't cover 82270 for diagnostic testing anymore

If you're still using the same code for fecal occult blood tests (FOBTs), you won't receive any reimbursement from Medicare this month.

Watch out: As of April 1, Medicare will no longer accept fecal occult blood code 82270 under the fecal occult blood test coverage policy. Instead, you have to use blood occult peroxidase code 82272, according to Medicare Change Request 4328, dated Feb. 17.

Difference: The descriptor for 82272 requires your physician to collect a single specimen via digital rectal exam (DRE). You can't use this code if you send the patient home with a specimen card to collect multiple samples, say experts. A single sample collected via DRE isn't clinically useful for screening purposes, so chances are if your physician collects a single specimen, it's a diagnostic test.

Screening: If you perform a fecal occult blood test for screening purposes, you should use G0107, says Deb Arneson, coder with the Kernodle Clinic in Burlington, NC. This code is just for screenings and involves sending the patient home with a card to collect multiple samples. It doesn't come out of the patient's deductible because it's part of the preventive medicine benefit.

For diagnostic testing, where the patient has a particular symptom such as rectal bleeding, you should use 82272 instead, says Arneson. This is included in the patient's deductible.

Documentation: To withstand an audit on these codes, you should make sure your documentation spells out how the specimen was collected, whether via DRE or take-home cards, says Larry Levine, a coder with Howard University Hospital in Washington, DC. The documentation should mention how many samples the doctor collected and the reason for collecting the samples.

Example: The documentation may show something like "stool guiac negative for blood," and that's your signal to bill for 82272 , says Debbie Miller, a coder with Duluth Internal Medicine Associates in Duluth, IA.