When to bill for FIT test

maryek28@outlook.com

Contributor
Messages
24
Location
Anchorage, AK
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Hi all,
Our clinic has recently started doing FIT tests. My question is, do we bill for the test when the patient is given the kit or wait until the patient brings it back? Sometimes the patient never returns with the kit and I don't feel like we can bill for that since the test was never actually performed.
 

karamac

Networker
Messages
34
Location
Glendale, Arizona
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Hi,

My recommendation is that you do not bill for any testing that you have not performed, as there is no result for the testing, and the provider has not actually done anything to support the billing of the code. While I know that you are based in Anchorage, below is a link to BCBS of Alabama's coding guidance in case you needed it. FIT testing is a little more complicated from a patient education and compliance standpoint than many providers assume. I also included a link to Aetna's policy-- while you may not have Aetna in your practice, they tend to be a good resource.






Colon Cancer is the second leading cause of cancer death in the United States, but it is up to 90 percent preventable through screening. The U.S. Preventive Services Task Force recommends that adults over age 50 be screened with one of the following tests: fecal occult blood (FOBT), sigmoidoscopy or colonoscopy. While each CRC screening test has advantages and disadvantages, FOBT offers a low-cost, non-invasive means of testing.

There are two main FOBT technologies: guaiac or gFOBT and fecal immunochemical tests or FIT. Due to the low return rate of specimens, many physicians opt for an in-office gFOBT with a stool sample collected from a digital rectal exam. However, a gFOBT performed during a digital rectal exam is not a sufficient screening test. Usually only one sample rather than the recommended three is obtained. The patient has rarely undertaken dietary preparation or medication precautions, and these increase the risk of false positive results. There is also always the concern that digital rectal examination will generate minor trauma and lead to a positive result.

gFOBT Digital Rectal Exam - Current Procedural Terminology (CPT®) Code: 82272—blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, single specimen (e.g., from digital rectal exam).

When gFOBT is used as a screening test, the patient should be given instructions for dietary restrictions and use of medications along with a kit to use at home to collect three consecutive stool samples. Patients should be encouraged to return the test kits to the physician.

gFOBT as a Screening Test - CPT Code: 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 3 cards or single triple cord for consecutive collection)

The FIT test is a newer kind of test that also detects occult (hidden) blood in the stool. This test reacts to part of the human hemoglobin protein. This test is more specific for bleeding in the lower GI tract. The FIT is done essentially the same way as the FOBT, but some patients may find it easier to use because there are no drug or dietary restrictions (vitamins or foods do not affect the FIT) and sample collection takes less effort. The correct CPT code in this instance is:

FIT Test CPT Code: 82274—blood, occult by fecal hemoglobin determination by immunoassay, qualitative, feces, 103 simultaneous determinations. Alternately, Healthcare Common Procedural Coding System (HCPCS) code G0328—colorectal cancer screening; fecal occult blood test, immunoassay 1-3 simultaneous may be used.
 
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