Choose FOBT Code Based on Test Type -- Here's How
Published on Fri Jul 20, 2007
Location of FOBT is critical to correct coding When a patient reports to your FP for a fecal occult blood test (FOBT), knowing why and how the physician tested the individual are indispensable pieces of coding information.
Why? There are many different types of patients who might report to the FP for guaiac-based FOBT -- the patient may or may not have symptoms, and the test could be diagnostic or for screening purposes. Further, the FP can conduct one of two FOBTs, depending on the situation.
As a result, you-ll need to carefully read the documentation to determine the correct coding for FOBT before filing your claim. Reporting the wrong type of FOBT will likely result in a denial and some carriers- red flags for your practice.
If Patient Has Symptoms, Report 82272
When your FP performs an FOBT prompted by a patient's symptom(s), you-ll typically report 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) for the service.
-You-ll use 82272 when the patient already has a problem, such as a complaint of rectal bleeding. The physician will conduct the test to see if there is currently any bleeding,- says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. The FP collects the specimen as part of a digital rectal exam (DRE) in the office.
Check out these indicators that might warrant diagnostic FOBT testing from Medicare's National Coverage Determination (NCD):
- To evaluate known or suspected alimentary tract conditions that might cause bleeding into the intestinal tract.
- To evaluate unexpected anemia.
- To evaluate abnormal signs, symptoms or complaints that might be associated with blood loss.
- To evaluate patient complaints of black- or red-tinged stools. Another way to identify 82272 is the number of specimens the physician collects. For 82272 claims, the physician will collect one fecal specimen from the patient while he is in the office.
Example: A patient complaining of rectal bleeding reports to the FP. The physician performs a DRE, collecting one fecal specimen. The physician's office then performs an FOBT on the specimen.
In this scenario, the FP collected a single in-office specimen during a DRE. On the claim, you should report 82272 for the FOBT.
Also, attach 569.3 (Hemorrhage of rectum and anus) to 82272 to reflect the patient's bleeding.
Make Sure Patient Takes Test Home for 82270
Although in-office FOBTs have their own code, you-ll use different codes to report the -take-home- FOBT, Witt says. During a take-home test (which the FP orders for screening purposes), the patient brings the cards home, obtains the samples himself and returns them to the physician, she says.
When the FP orders a take-home FOBT test, you should report 82270 for the [...]
