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 [...]