LCD for Occult Blood, Feces Testing (L1363)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L1363 

 

LCD Title 

Occult Blood, Feces Testing 

 

Contractor's Determination Number 

1363 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.

Section 4104 of the 1997 Balanced Budget Act

HCFA Pub. 60AB Rev. AB-97-24 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 10/16/1997  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 04/13/2007  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

This policy represents Riverbend's implementation of the National Coverage Decision (NCD) on Fecal Occult Blood Tests and of Medicare Coverage of Colorectal Cancer Screening Tests.

Blood, occult; feces screening, 1-3 simultaneous determinations. Occult blood tests are performed to detect GI bleeding and for the early detection of colorectal cancer.

Indications:


1. To evaluate known or suspected alimentary tract conditions that might cause bleeding into the intestinal tract.

2. To evaluate unexpected anemia.

3. To evaluate abnormal signs, symptoms, or complaints that might be associated with loss of blood.

4. To evaluate patient complaints of black or red-tinged stools.



Limitations:


1. The FOBT is reported once for the testing of up to three separate specimens (comprising either one or two test per specimen.)

2. In patients who are taking non-steroidal anti-inflammatory drugs and have a history of gastrointestinal bleeding by no other signs, symptoms, or complaints associated with gastrointestinal blood loss, testing for occult blood may generally be appropriate no more than once every three months.

3. When testing is done for the purpose of screening for colorectal cancer in the absence of signs, symptoms, conditions, or complaints associated with gastrointestinal blood loss, The HCPCS code for Colorectal cancer screening; fecal-occult blood test, (1-3 simultaneous determinations) should be used. Coverage of colorectal cancer screening is described in CMS Transmittal 1062, CR 5292, November 22, 2006.


Other Comments

1. Screening fecal-occult blood tests are covered at a frequency of once every 12 months for beneficiaries who have attained age 50 (i.e., at least 11 months have passed following the month in which the last covered screening fecal-occult blood test was done.) Screening fecal-occult blood test means a guaiac-based test for peroxidase activity, or an immunoassay-based test in which the beneficiary completes it by taking samples from two different sites of three consecutive stools. This screening requires a written order from the beneficiary's attending physician. (The term "attending physician" is defined to mean a doctor of medicine or osteopathy (as defined in §1861(r)(l) of the Act) who is fully knowledgeable about the beneficiary’s medical condition, and who would be responsible for using the results of any examination performed in the overall management of the beneficiary’s specific medical problem.)

2. In patients who are taking non-steroidal anti-inflammatory drugs and have a history of gastrointestinal bleeding but no other signs, symptoms, or complaints associated with gastrointestinal blood loss, testing for occult blood may generally be appropriate no more than once every three months.
 

 

Coverage Topic 

Lab Services
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12x

Hospital-inpatient or home health visits (Part B only)

13x

Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)

14x

Non-Patient Laboratory Specimens

22x

SNF-inpatient or home health visits (Part B only)

23x

SNF-outpatient (HHA-A also)

85x

Special facility or ASC surgery-rural primary care hospital (eff 10/94)

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

030X

Laboratory-general classification

031X

Laboratory pathological-general classification

 

 

CPT/HCPCS Codes 

 

82270

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIMENS WITH SINGLE DETERMINATION, FOR COLORECTAL NEOPLASM SCREENING (IE, PATIENT WAS PROVIDED 3 CARDS OR SINGLE TRIPLE CARD FOR CONSECUTIVE COLLECTION)

82272

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS, PERFORMED FOR OTHER THAN COLORECTAL NEOPLASM SCREENING

82274

BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS

G0328

COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS

 

 

ICD-9 Codes that Support Medical Necessity 

Refer to the Clinical Diagnostic Laboratory Services -National Coverage Decisions (NCDs) for the ICD-9 code requirements.

XX000

Not Applicable

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

Documentation supporting medical necessity of this item, such as ICD-9 codes, must be submitted with each claim. Claims without such evidence will be denied. 

 

Appendices 

 

 

Utilization Guidelines 

 

 

Sources of Information and Basis for Decision 

Carrier Policy

HCFA Pub. 60AB Rev. AB-97-24 

 

Advisory Committee Meeting Notes 

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives. 

 

Start Date of Comment Period 

08/01/1997 

 

End Date of Comment Period 

 

 

Start Date of Notice Period 

09/15/1997 

 

Revision History Number 

1363c 

 

Revision History Explanation 

01/17/2003 Deleted ICD-9 code information already contained in the NCD

07/24/2002 Formatted

04/02/2002 Deleted obsolete codes from 11/08/01 revision

01/18/2002 Updated codes (Negotiated Rulemaking: Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services; Final Rule: Nov 2001)

11/08/2001 Revision to ICD-9 codes

11/13/2000 updated ICD-9 codes with ICD-9 Code Book 2001, added codes and separated codes for clarity.

11/26/2005 - The description for CPT/HCPCS code 82270 was changed in group 1

This LCD was converted from an LMRP on 12/6/2005

05/16/2006 Deleted CPT/HCPCS code 82270 and added CPT/HCPCS 82272 per CR 4328

7/2/2006 - The description for Bill code 14 was changed

11/18/2006 - The description for CPT/HCPCS code 82272 was changed in group 1

11/18/2006 - CPT/HCPCS code G0107 was deleted from group 1

04/13/2007 - CPT/HCPCS code 82270, 82274 and HCPCS code G0328 was added to group 1. Policy Indications and Limitations of Coverage and/or Medical Necessity and Other Comments updated. Bill Type Codes 22X, 23X, and 85X added.

11/10/2007 - The description for CPT/HCPCS code 82270 was changed in group 1
11/10/2007 - The description for CPT/HCPCS code 82272 was changed in group 1 

 

Reason for Change 

 

Last Reviewed On Date 

12/12/2007 

 

Related Documents 

Article(s)
A37877 - Occult Blood, Feces Testing

 

LCD Attachments 

FAQ - Comment and Response (3,290 bytes)

 

Other Versions 

Updated on 11/10/2007 with effective dates 04/13/2007 - N/A

Updated on 04/13/2007 with effective dates 04/13/2007 - N/A

Updated on 04/13/2007 with effective dates 04/13/2007 - N/A

Updated on 09/01/2006 with effective dates 04/03/2006 - 04/12/2007

Updated on 07/02/2006 with effective dates 04/03/2006 - N/A

Updated on 05/16/2006 with effective dates 04/03/2006 - N/A

Updated on 12/06/2005 with effective dates 12/07/2005 - 04/02/2006

Updated on 12/06/2005 with effective dates 01/17/2003 - 12/06/2005

Updated on 03/11/2003 with effective dates 01/17/2003 - N/A

Updated on 02/15/2003 with effective dates 01/17/2003 - N/A

Updated on 01/17/2003 with effective dates 01/17/2003 - N/A

Updated on 01/17/2003 with effective dates 01/17/2003 - N/A

Updated on 10/04/2002 with effective dates 07/24/2002 - 01/16/2003