Primary Care Coding Alert

10 do's and don-ts put your FOBT coding on the path to payment
 
Eliminate the confusion that countless coders face with claims for 82270, 82272 and G0107 with this handy FOBT coding checklist.

For 2006, CPT includes three family physician commonly used fecal occult blood test (FOBT) codes:

- 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)

- 82272 -- Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g., from digital rectal exam)

- G0107 -- Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations.

Follow This Expert Advice

Do: Report the take-home test (82270, G0107) when the patient returns the cards, not when the physician orders the test, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. Why: Code 82270 is for the lab analysis. -The service is not performed until the cards are returned,- Callaway says.

Do: Reserve the code for a screening test. The code's descriptor specifies -for colorectal neoplasm screening.-

Do: Link 82272 to an ICD-9 code representing a sign, a symptom or a screening. Rule: Report 82272 when the physician collects a single specimen usually in the office setting after a digital rectal exam (DRE). The FP may conduct the test due to signs or symptoms or in conjunction with a preventive medicine service.

Do: Reconsider reporting 82270 and 82272 on the same date of service. Although the National Correct Coding Initiative , version 12.0, allows a modifier to override this FOBT code bundle, a patient would not normally return the cards on the same day as the in-office exam and test. Strategy: In the rare event that an individual does go home, collects three stool samples and returns them to your office on the same day the FP performs an in-office DRE, you should assign modifier 59 (Distinct procedural service) to 82272 to indicate that the take-home test occurred at a separate session from the in-office test.

Do: Use G0107 for a take-home screening test, not for an in-office specimen collection performed during a DRE. Medicare still requires you to use G0107 for a screening FOBT. Because 82270 could represent a screening or a diagnostic test, the G code allows Medicare to automatically identify a screening test. Beneficiaries age 50 and older qualify for annual G0107 coverage if the patient:

1. takes the cards home
2. obtains the samples from two different sites of three consecutive stools
3. returns them to the physician.

Avoid These Potential Pitfalls

Don-t: Require patients to collect specimens on different days. The AMA only stipulates that the collections must occur consecutively, not on different dates.

Don-t: Bill 82270 per collection. The number of samples the lab receives does not affect 82270 billing. Instead: You should use 82270 -for analysis of peroxidase activity, irrespective of the number of samples received,- according to CPT Changes 2006: An Insider's View, published by the AMA. If the FP asks the patient to collect and return three consecutive samples, you should record one unit of 82270.

Don-t: Assume reporting 82272 precludes reporting 82270. You could report 82272 as well as another screening test for the same patient stemming from the same encounter. -If a physician does 82272 as part of a screening process, he still needs to do a screening test, such as 82270 and G0107 describe,- says Bruce Rappoport, MD, CPC, a consultant for Rachlin, Cohen & Holtz LLP in Fort Lauderdale,.

Don-t: Count a single-specimen office collection as part of a preventive medicine service. -Some insurance carriers bundle urine tests into the physical exams already, so we will be surprised if 82272 is a covered service,- says LuAnne Bergstrom, office manager at Spring Garden Family Practice in York, Pa.

But Medicare does allow payment for 82272, as well as 82270 and G0107. Problem: You will not find these codes listed on the National Physician Fee Schedule, says  Bobbi Fioravanti, office manager for Dr. Fred Fioravanti in Saxonburg, Pa.

Reason: Medicare pays FOBTs on the clinical lab fee schedule. -The allowance will range from $3.64 to $4.54 for each one, depending on the Medicare locality,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. You can download the fee schedule at www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp#TopOfPage.

Don-t: Report G0107 when a patient returns guaiac  cards that an FP ordered for a sign or symptom. If the test is related to a medical condition, you should instead use 82270 even for Medicare, Callaway says. -Medicare only wants G0107 when the service is screening.-