G0328 or 82274? which CPT has to choose,- Rules

G0328 or 82274? Choose Just 1 Fecal Blood Code

NCCI 10.2 bundles all FOBT code combinations

If you didn’t get the message from Medicare’s immunoassay fecal-occult blood test (iFOBT) coverage rules, you’ll get the message from the latest National Correct Coding Initiative (NCCI) edits — you must report either G0328 (Fecal blood screening immunoassay) or 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations) for the iFOBT test.

NCCI 10.2, which took effect July 1, added a mutually exclusive edit pair that bundles G0328 and 82274 together. A”0″ modifier indicator means that you cannot under any circumstances override the edit pair for Medicare payment.

‘Reason for Test’ Drives Coding

Medicare recognizes the two iFOBT codes based on whether the physician orders the test for colorectal cancer screening (G0328) or for a diagnostic purpose (82274).

You should use the HCPCS Level II code if the ordering physician states that the FOBT is for colorectal cancer screening or requests the test with a screening code such as V76.51 (Special screening for malignant neoplasms; colon), according to Anne Pontius, MBA, CMPE, MT (ASCP), president of Laboratory Compliance Consultants Inc., in Raleigh, N.C.

Earlier NCCI Bundled Guaiac FOBT

Medicare also covers guaiac-based FOBT (gFOBT) for diagnostic purposes (82270, Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations) or colorectal cancer screening G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations).

The latest NCCI edits’addition of the G0328/82274 code pair completes FOBT code bundling. NCCI continues to include the following code pairs added in previous NCCI versions: G0107/82270, 82274/82270, G0328/82270 and G0328/G0107.

Bottom line: You must select only one FOBT test code based on the lab method used and the reason for the test (screening or diagnostic).

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