Primary Care Coding Alert

Whether a practice can report diagnostic guaiac tests performed during a digital rectal exam (DRE) is a hotly contested issue in family practice coding. Some professional coders maintain that the code describing the service (82270, blood, occult, by peroxidase [e.g., guaiac]; feces, 1-3 simultaneous determinations) can only be reported when patients collect samples at home. Others contend that the test represents a discrete service during a DRE in the office and may appropriately be reported under those circumstances as well.

CPT and the majority of third-party payers support this latter position. Although a few insurers deny claims for 82270 when it is done in the office during an exam, most pay for the test as well as the E/M service.

Fecal occult blood tests (FOBTs) are used to determine if a patient has blood in the stool, explains Linda Parks, MA, CPC, coding supervisor for Atlanta Gastroenterology Associates in Atlanta, a 22-physician practice. One or more stool samples is obtained and treated with a developer. The samples are then examined under special lighting, and a change in color reveals whether blood is present.

In some cases, an FP will collect the sample during DRE. In other cases, a packet of three cards is sent home with the patient, who is asked to take stool samples at three different times. The cards are then returned to the office, where testing and determinations are made. It takes only one positive to identify blood in the stool, but three negative to determine a negative test.

How to Code FOBTs and Office Visits

An FP examines a patient and performs a DRE, which includes a stool sample that will be tested in the office. Coders should assign the appropriate E/M service (e.g., 99213, office or other outpatient visit, established patient) as well as 82270.

Coding experts cite two reasons that both may be billed. One strong argument can be found in the code description itself, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Systems Inc., which supports family practice physicians in Broomfield, Colo. It says the test includes one to three determinations. The physicians sample is one determination, which allows the service to be reported separately.

Parks says CPT has taken a clear stand on this issue, noting that the actual performance and/or interpretation of diagnostic tests or studies ordered during a patient encounter are not included in the levels of E/M services. Physician performance of diagnostic tests or studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code.
[...]