If you want to keep the money coming for in-office examination of fecal occult blood test (FOBT), you should train eyes on the difference between three hemoccult codes and their purpose.
Here's a scenario:
A 60-year old patient presented in the office complaining of diarrhea preceded by intestinal cramping, which lasted two weeks. The patient has no history of cancer in the family. He also did not feel nauseous at all. The physician took a stool sample to test for both parasites and blood. How should you approach this situation?
Assign the right code for each type of collection
Since the year 2007, CPT has assigned two codes that you can use for post digital rectal exam (DREs) and consecutive specimen collection:
Update: With effect from January 1, 2007, CPT has terminated HCPCS code G0107 and replaced by 82270 even for routine Medicare screening FOBT.
Remember: In the above scenario, it is not clear whether the doctor examined the samples herself or sent them to the lab. But as a general rule, parasite exams almost always take place in the lab. Here, the lab would be paid for the test directly.
Do not forget: There are interval limitations for screenings established by Medicare and most commercial carriers.
On the other hand, if a patient presents to the office with symptoms, the gastroenterologist would carry out a diagnostic FOBT, and you should bill it with 82272. One can bill CPT 82272 if 1 to 3 specimens are obtained. The diagnosis code for the test would be related to the patient's presenting symptoms.
Count number of tests
If you are still not sure whether you have got the right code by differentiating screening from diagnostic, you can look further into the test's details. Identify how many tests the gastroenterologist or lab performs. For a three-specimen collection, you would go for 82270. Use a single-specimen collection with 82272.
Red flag: Even though 82270 involves analysis of three specimens, you should always assign 82270 with a “1" in the units field. Some coders incorrectly interpret 82270's descriptor of “one to three simultaneous determinations" to mean they should bill “each of the three determinations with one unit of CPT 82270 (82270 x 3)." The revised description more clearly reminds providers that the code identifies as many as three consecutive determinations.
What if: The patient fails to collect all three samples. You may still bill 82270. If this happens, the laboratory should carry out analysis of the one or two collected specimen, report the results accordingly and record one unit of 82270.
Determine who obtains the sample
Where the sample is collected and who performs it can also include you in to the right FOBT code. CPT Code 82270 will always be billed as a separate service when the developer has been placed on the cards after the three completed cards (or one completed triple card) have been returned to the office. In a nutshell, the doctor should not collect the specimen in the office.
Instead you should use 82272 when the doctor carries out a digital rectal exam in the office and obtains a sample at that time.
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