Primary Care Coding Alert

Tip: Zero in on collection number and insurer when choosing among 82270, 82272 and G0107

If you-re still struggling to learn the rules for reporting 82272 -- new in 2006 -- chances are good you are leaving money on the table for your FOBT services.

These scenarios will show you how the terms -screening- and -diagnostic- affect your coding for fecal occult blood test (FOBT). 

Consider 82272 Primarily a Diagnostic Test

First, don't pigeonhole 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) as strictly diagnostic or screening. -In the CPT Manual, - 82272 does not state diagnostic or screening,- says Whitney Coverdale, CPC, medical records specialist/compliance officer at Family Practice Associates in Holton, Kan.

Typical way: The service that 82272 represents is typically performed as a diagnostic test, says Bruce Rappoport, MD, CPC, a consultant for Rachlin, Cohen & Holtz LLP in Fort Lauderdale, Fla. -The physician collects the specimen during an office visit typically for a diagnostic reason,- meaning the patient has signs or symptoms that indicate medical necessity for the test, Rappoport says.

Example 1: A 57-year-old patient presents with abdominal pain and dark stools. The physician collects a sample during a digital rectal exam.

-You should report the stool analysis with 82272,- Rappoport says, referring to the AMA's clinical example for 82272 as published in CPT Changes 2006: An Insider's View. Because the physician orders the test for a symptom (789.00, Abdominal pain, unspecified site) that the patient has, the service is diagnostic.

Use 82272 for In-Office Single-Specimen Collection

FPs sometimes collect a specimen during the rectal exam portion of a patient's yearly age-appropriate preventive medicine service. So you may encounter cases in which a physician performs 82272 in the absence of signs or symptoms.

Example 2: A physician performs a digital rectal exam (DRE) in the office (single determination) for screening purposes. Because the test involves a single collection, you should assign 82272, regardless of the service's reason. CPT added 82272 to the FOBT series -to provide a mechanism for reporting tests performed on a single specimen,- states the AMA in CPT Changes 2006: An Insider's View.

Problem: The test that 82272 describes is not an adequate screening tool, said J. Leonard Lichtenfeld, MD, the American College of Physicians CPT representative, in his FOBT speech at the CPT 2006 Coding Symposium. When a physician performs digital FOBT -as part of a primary-care preventive exam, negative results do not decrease the odds of advanced neoplasia,- Lichtenfeld said, citing an article in the Annals of Internal Medicine. -Persons with these results should be offered at-home three-sample FOBT or another type of screening tool,- according to -Account of Screening for FOB or a Single Stool Sample Obtained by DRE.-

Lesson learned: Although single-specimen collection alone is an inadequate screening tool, in the daily practice of medicine, physicians may perform 82272 as part of a screening or diagnostic service. Therefore, you don't need to focus so much on an FOBT's purpose. Best bet: -Use 82272 when the provider collects a specimen during an exam,- Rappoport says.

Identify Insurer to Decide Between 82270 and G0107

When the FP orders a three-specimen take-home FOBT for screening purposes, you should report either 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]) or G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations).

-Given the explicit language in 82270's descriptor -- for colorectal neoplasm screening -- you should treat it as a screening code for most payers, except Medicare,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Report take-home screening tests to Medicare carriers with G0107.

Example 3: An FP sees a 72-year-old patient for follow-up of hypertension and diabetes. During the visit, the physician discusses the importance of colorectal cancer screening with the patient. The physician sends the patient home with a screening kit that includes three FOBT cards and instructions for specimen collection and return.

You should report the specimen analysis with 82270 or G0107, Rappoport says, referring to 82270's clinical example as written by the AMA. -The FOBT involves the physician giving the patient three cards to take home and return for analysis,- he says.

Key: For you to bill 82270, the patient -has to take the test card home,- says Lichtenfeld, who is also deputy chief medical officer for the American Cancer Society. -The physician can't do the test in the office.-

Test Your Knowledge With 4 Scenarios

Apply the above lessons to the following real-world coding examples provided by Bobbi Fioravanti, office manager for Dr. Fred Fioravanti in Saxonburg, Pa.

Case 1: An FP gives a patient three FOBT cards to take home for a screening.

You code 82270 or G0107 based on the patient's insurer. The three-card take-home kit meets the criteria for 82270 and G0107. Use 82270 for private payers, and G0107 for Medicare carriers.

Case 2: An FP gives a patient three sample cards for at-home collection due to a sign or symptom.

You code 82270. Although 82270 is for a screening, and the patient had a sign or symptom, the in-office test may have been negative, which led the physician to decide further study was necessary using a three-card collection, Rappoport says. Because the test is for a medical condition, you would use 82270, regardless of insurer.

Case 3: During a screening DRE, an FP collects a stool sample.

You code 82272. Rappoport says to assign 82272 whenever a provider collects a sample at exam time.

Case 4: Because a patient has a sign or symptom, the FP performs a DRE and collects a stool sample.

You code 82272. Classify all single-specimen collections as 82272; the reason for the test doesn't affect the coding.