Primary Care Coding Alert

Question: Which diagnoses does Medicare cover for the screening fecal- occult blood test (FOBT)?

Ohio Subscriber Answer: When your family physician performs a guaiac test as a colon cancer-screening exam, you should link G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) to V76.41 (Special screening for malignant neoplasms; other sites; rectum) or V76.51 (Special screening for malignant neoplasms; intestine; colon).

Medicare will cover G0107 if the beneficiary:

hasn't had a colorectal cancer screening in the past 11 months (Medicare covers a screening for colon cancer once every 12 months)

is age 50 and older

takes the cards, obtains samples and returns them to you

takes the samples from two different sites of three consecutive stools

is asymptomatic. If the patient has symptoms, such as bleeding, you should instead report 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations) with the known or suspected alimentary tract conditions, such as 564.1 (Functional digestive disorders, not elsewhere classified; irritable bowel syndrome). - Answers to You Be the Coder and Reader Questions provided by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; Lorna Powell, CCS-P, owner of Quality Medical Management in Elk City, Okla.; and Linda Walsh, senior health policy analyst with the American Academy of Pediatrics Division of Health Care Finance and Practice.