I have a number of questions about how to code appropriately for a fecal-occult blood test: What CPT codes should be submitted when this test is done on non-Medicare patients with commercial health plans?Does it make a difference in the coding whether the test is done for diagnostic or screening purposes?How should the test be coded differently for Medicare patients?Can we submit a code for the test even if it's done without an office visit, or does the patient have to review the card with the physician?If the physician does one test with the patient in the office and then the patient collects another sample at home and mails it in for another test, can we code the test twice?
There are two CPT codes for fecal-occult blood tests: 82270, “Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1–3 simultaneous determinations,” and 82274, “Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1–3 simultaneous determinations.”For most payers other than Medicare, either code may be used for screening or diagnostic tests. The purpose of the test should be indicated by the ICD-9 code that accompanies the CPT code on the claim form. If the test is done for screening purposes (e.g., for colorectal cancer), you should submit the appropriate ICD-9 code from the V76 series (e.g., V76.41, “Special screening for malignant neoplasms; other sites; rectum,” or V76.51, “Special screening for malignant neoplasms; intestine; colon”). If the test is done for diagnostic purposes, you should submit the appropriate ICD-9 code for the sign or symptom that prompted you to order the test.Medicare considers CPT code 82270 to be a diagnostic test rather than a screening test. So, for fecal-occult screening tests, Medicare has its own code, G0107, “Colorectal cancer screening; fecal-occult blood test, 1–3 simultaneous determinations,” which is reimbursed once every 12 months. Note that with G0107, the patient must take the cards home, obtain samples and return them to you before the coverage criteria described in the Medicare Carriers Manual is met: “Screening fecal-occult blood test means a guaiac-based test for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools.” Obtaining one specimen during the annual exam is insufficient for G0107.A fecal-occult blood test may be billed independent of an office visit. For example, a patient presents for an office visit and is given a sample collection card to take home on June 1; that same day, a claim for the office visit is filed. On June 4, the completed card is returned and the test is done. It would be appropriate to submit a separate claim on June 4 for just the fecal-occult blood test.Finally, if you perform one test in the office and the patient collects another sample at home and mails it in for another test, the appropriate CPT code for the test may be submitted twice – once for the date the test was done in the office and once for the date the test was done with the returned sample. In this scenario, the determinations are not simultaneous (i.e., not done at the same time) as called for in the code descriptors, so each determination represents a separate instance of the test. Note, however, that no codes may be submitted before a specimen(s) has been returned and analyzed. Simply providing a patient with a set of specimen collection cards is not sufficient for coding purposes. Also be aware this does not apply to Medicare screening tests as noted above.