Coding for screening and diagnostic fecal occult blood test

Key Points

Q: I am looking for help with CPT codes 82270 and 82272. The wording for these 2 codes is confusing because they are so similar. Code 82270 includes the wording "consecutive collected specimens with single determination, for colorectal neoplasm screening." Code 82272 includes the wording "1 to 3 simultaneous determinations, performed for other than colorectal neoplasm screening." When should we bill each of the codes, and can we bill 82272 if only 1 specimen is obtained-say, during a digital rectal exam?

A: Let's break down your query to the 2 questions you'll need to answer to determine which test, if any, should be billed.

If the test is for screening purposes, then you should bill 82270. This code always will be billed as a separate service when the developer has been placed on the cards after the 3 completed cards (or 1 completed triple card) have been returned to the office.

If a patient presents to the office with symptoms, however, a diagnostic fecal occult blood test (FOBT) would be performed and billed (82272). Code 82272 can be billed if 1 to 3 specimens are obtained (we'll discuss how to determine the number of specimens needed in the section below).

As we discussed above, for the screening test (82270), 3 consecutive stool specimens must be sampled. This means that the triple card or 3 separate single cards must be completed.

The number of specimens required for a diagnostic FOBT depends on the severity of the patient's problems, however. For example, if the patient presents with a complaint of severe abdominal pain and black, tarry stools, the physician would need to know immediately whether the patient has evidence of active gastrointestinal bleeding. If the physician collects 1 specimen, developer is added to check the color, and blood is found in the stool, then there is no need to collect 2 additional specimens because the physician is able to diagnose the problem without them.

On the other hand, if a patient presents with abdominal cramping on and off for the past 2 months, the situation is significantly less urgent and the physician would opt to send the patient home with 3 cards (or 1 triple card) to return to the office. In this situation, code 82272 would be billed when the card(s) are returned to the office and developer has been added.

If a screening FOBT is performed and only 1 specimen is collected, this is not a billable service. As we discussed earlier, code 82270 should be used for screening purposes, and this code requires 3 specimens in order to correctly be billed. Three specimens are required because internal medicine studies have shown that 1 specimen does not meet the threshold of being a "reasonable" means to screen for colorectal cancer.

The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Do you have a primary care-related coding question that you would like our experts to address in this column? Send it to medec@advanstar.com
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