Pathology/Lab Coding Alert

Question: Would you please clarify when to use G0107 versus 82270 for fecal-occult blood tests? If the lab interprets the Hemoccult cards that include three smears, should we report one or three units of service?

Texas Subscriber


Answer: Use G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) when reporting a screening fecal-occult blood test (FOBT) to Medicare. The physician orders a screening test in the absence of signs or symptoms of disease using diagnosis code V76.51 (Special screening for malignant neoplasms, colon). Medicare restricts payment for screening FOBT to once every 12 months for patients who are at least 50 years of age.
 
If the physician orders the same test for diagnostic purposes, such as the guaiac-based assay for peroxidase activity, report CPT 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations). According to Medicare's National Coverage Determination (NCD) for FOBT, indications for the diagnostic test include signs and symptoms of blood loss, anemia or intestinal bleeding. Medicare also requires 82270 for asymptomatic patients with a history of intestinal bleeding who are now taking nonsteroidal anti-inflammatory medication.
 
Do not report multiple units of 82270 or G0107 for tests that involve three smears. The code definitions specify "1-3 simultaneous determinations." The FOBT NCD states, "Code 82270 is reported once for the testing of up to three separate specimens (comprising either one or two tests per specimen)."