After a busy Monday at the clinic, I sat down to look at some journals while our supper was warming up in the oven. An article in Medical Economics caught my attention. It made me first a little bemused, but that soon changed into something between anger and sadness.
Under the heading “Coding Cues” a question was posed about how to bill insurances for fecal occult blood testing – those little cards we use to see if a stool sample has blood in it. The answer exceeded 400 words in length. I looked up what the reimbursement is – $4.54, less in some states.
The essence of the article is that, as the simplest of all screening tests for colon cancer, you cannot bill for only one test. You must hand out, and charge for, three of them (CPT code 82270). As a diagnostic test for blood in the stool, if the first one is positive, doing three is a waste of money (CPT code 82272). An unclear clinical scenario may require 3 samples to determine the presence of blood (CPT code 82272). Choosing the wrong CPT code for the wrong scenario means no payment, even though both codes represent stool testing for blood.
A few years ago, our clinic seemed to talk about these hemoccult cards a lot. At that time providers were simply forgetting to charge for them. I had no idea how complicated the subject was, since I am several steps removed from the billing process. It is not hard to imagine why our health care system is in shambles when a test that costs less than $5 is so complicated to charge and bill for that it becomes a full-page article in a Family Practice business magazine.
Someone is clearly watching over us with incredible suspicion and mistrust. And we are surely being micromanaged.
A Country Doctor Writes: 
A very interesting thought. Look forward to reading more, thanks