Pathology/Lab Coding Alert

Changes clear up card and DRE confusion

If you're puzzled about when and how to bill for a fecal occult blood test (FOBT) card sent home with the patient, you're not alone. Billing for each specimen on an FOBT card has always been a fraudulent practice, but the 2006 code changes help to clarify that point.

The clarification comes from CPT revising the existing 82270 for the take-home card, which uses multiple specimens, and adding 82272 for a single specimen that the physician collects as part of a digital rectal exam (DRE). Select the Code by Method and Specimen The new and revised CPT codes, along with existing codes for occult blood tests, are as follows:

• 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)

• 82271--...other sources

• 82272--Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g.,  from digital rectal exam)

• 82274--Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations. To select the proper code from this list, first you have to know whether the lab uses an immunoassay or a guaiac-based hemoglobin test. The immunoassay test identifies the globulin portion of the molecule. On the other hand, the guaiac-based test shows peroxidase activity in the heme moiety.

How it works: For the guaiac-based test, select 82270, 82271 or 82272. Use 82271 for any source other than feces. "For fecal specimens tested for peroxidase activity, you'll have to choose between revised code 82270 and new code 82272," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, CEO of Chargemaster

Maintenance Services, a laboratory consultation company in Portland, Ore.

Use 82270 when the patient collects multiple consecutive specimens and sends the card to the lab for a single determination. When the physician collects a single fecal specimen from a DRE, report 82272. If the lab performs the immunoassay test, you should report the service as 82274.

Get the Date of Service Right The date of service for lab tests is the date of specimen collection. Although the date is clear when the physician takes the specimen and submits it for an 82272 service, what date should you use when the physician sends the patient home with a card?

For 82270, the lab should use the date it receives the card as the date of service. Many coders become confused about the date of service for FOBT codes, says Donna Beaulieu, consultant with Quality Physician Services in Stockbridge, Ga. But Medicare does not want you to use the date that the physician sends the patient home with the card.

Don't miss: You risk having to repay Medicare for the FOBT test if the physician [...]