National Coverage Determination Fecal Occult Blood Test ...

National Coverage Determination Procedure Code: 82272 Fecal Occult Blood Test

CMS Policy Number: 190.34 Back to NCD List

Description: The Fecal Occult Blood Test (FOBT) detects the presence of trace amounts of blood in stool. The procedure is performed by testing one or several small samples of one, two or three different stool specimens.

This test may be performed with or without evidence of iron deficiency anemia, which may be related to gastrointestinal blood loss. The range of causes for blood loss include inflammatory causes, including acid-peptic disease, non-steroidal antiinflammatory drug use, hiatal hernia, Crohn's disease, ulcerative colitis, gastroenteritis, and colon ulcers. It is also seen with infectious causes, including hookworm, strongyloides, ascariasis, tuberculosis, and enteroamebiasis. Vascular causes include angiodysplasia, hemangiomas, varices, blue rubber bleb nevus syndrome, and watermelon stomach. Tumors and neoplastic causes include lymphoma, leiomyosarcoma, lipomas, adenocarcinoma and primary and secondary metastases to the GI tract. Drugs such as nonsteroidal anti-inflammatory drugs also cause bleeding. There are extra gastrointestinal causes such as hemoptysis, epistaxis, and oropharyngeal bleeding. Artifactual causes include hematuria, and menstrual bleeding. In addition, there may be other causes such as coagulopathies, gastrostomy tubes or other appliances, factitial causes, and long distance running.

Three basic types of fecal hemoglobin assays exist, each directed at a different component of the hemoglobin molecule. 1. Immunoassays recognize antigenic sites on the globin portion and are least affected by diet or proximal gut bleeding, but the antigen may be destroyed by fecal flora. 2. The heme-porphyrin assay measures heme-derived porphyrin and is least influenced by enterocolic metabolism or fecal storage. This assay does not discriminate dietary from endogenous heme. The capacity to detect proximal gut bleeding reduces its specificity for colorectal cancer screening but makes it more useful for evaluating overall GI bleeding in case finding for iron deficiency anemia. 3. The guaiac-based test is the most widely used. It requires the peroxidase activity of an intact heme moiety to be reactive. Positivity rates fall with storage. Fecal hydration such as adding a drop of water increases the test reactivity but also increases false positivity.

Of these three tests, the guaiac-based test is the most sensitive for detecting lower bowel bleeding. Because of this sensitivity, it is advisable, when it is used for screening, to defer the guaiac-based test if other studies of the colon are performed prior to the test. Similarly, this test's sensitivity may result in a false positive if the patient has recently ingested meat. Both of these cautions are appropriate when the test is used for screening, but when appropriate indications are present, the test should be done despite its limitations.

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 tests per specimen). 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.

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, report the HCPCS code for colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations should be used.

Frequency Limitations: Patients who are taking non-steroidal anti-inflammatory drugs and have a history of GI bleeding but no other signs, symptoms, or complaints associated with GI blood loss: once every 3 months

To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

ICD-10 A02.0 A02.1

Descriptor Salmonella enteritis Salmonella sepsis

A03.0 A03.1 A03.2 A03.3 A03.8 A03.9 A04.5 A04.6 A04.8 A05.0 A05.1 A05.2 A05.3 A05.4 A05.5 A05.8 A05.9 A06.0 A06.1 A06.2 A06.3 A06.4 A06.5 A06.6 A06.7 A06.81 A06.82 A06.89 A06.9 A07.0 A07.1 A07.2 A07.3 A07.4 A07.8 A07.9 A09 A18.31 A18.32 A18.39 A18.83 A52.74

Shigellosis due to Shigella dysenteriae Shigellosis due to Shigella flexneri Shigellosis due to Shigella boydii Shigellosis due to Shigella sonnei Other shigellosis Shigellosis, unspecified Campylobacter enteritis Enteritis due to Yersinia enterocolitica Other specified bacterial intestinal infections Foodborne staphylococcal intoxication Botulism food poisoning Foodborne Clostridium perfringens intoxication Foodborne Vibrio parahaemolyticus intoxication Foodborne Bacillus cereus intoxication Foodborne Vibrio vulnificus intoxication Other specified bacterial foodborne intoxications Bacterial foodborne intoxication, unspecified Acute amebic dysentery Chronic intestinal amebiasis Amebic nondysenteric colitis Ameboma of intestine Amebic liver abscess Amebic lung abscess Amebic brain abscess Cutaneous amebiasis Amebic cystitis Other amebic genitourinary infections Other amebic infections Amebiasis, unspecified Balantidiasis Giardiasis [lambliasis] Cryptosporidiosis Isosporiasis Cyclosporiasis Other specified protozoal intestinal diseases Protozoal intestinal disease, unspecified Infectious gastroenteritis and colitis, unspecified Tuberculous peritonitis Tuberculous enteritis Retroperitoneal tuberculosis Tuberculosis of digestive tract organs, NEC Syphilis of liver and other viscera

A54.00 A54.02 A54.09 A54.1 A54.6 A54.83 B25.2 B68.0 B68.1 B68.9 B69.0 B69.1 B69.81 B69.89 B69.9 B70.0 B70.1 B71.0 B71.1 B71.8 B71.9 B75 B77.0 B77.81 B77.89 B77.9 B78.0 B78.7 B78.9 B79 B80 B81.0 B81.1 B81.2 B81.3 B81.4 B81.8 B82.0 B92 B94.2 B94.8 B94.9

Gonococcal infection of lower genitourinary tract, unsp Gonococcal vulvovaginitis, unspecified Other gonococcal infection of lower genitourinary tract Gonocl infct of lower GU tract w periureth and acc glnd abcs Gonococcal infection of anus and rectum Gonococcal heart infection Cytomegaloviral pancreatitis Taenia solium taeniasis Taenia saginata taeniasis Taeniasis, unspecified Cysticercosis of central nervous system Cysticercosis of eye Myositis in cysticercosis Cysticercosis of other sites Cysticercosis, unspecified Diphyllobothriasis Sparganosis Hymenolepiasis Dipylidiasis Other specified cestode infections Cestode infection, unspecified Trichinellosis Ascariasis with intestinal complications Ascariasis pneumonia Ascariasis with other complications Ascariasis, unspecified Intestinal strongyloidiasis Disseminated strongyloidiasis Strongyloidiasis, unspecified Trichuriasis Enterobiasis Anisakiasis Intestinal capillariasis Trichostrongyliasis Intestinal angiostrongyliasis Mixed intestinal helminthiases Other specified intestinal helminthiases Intestinal helminthiasis, unspecified Sequelae of leprosy Sequelae of viral hepatitis Sequelae of oth infectious and parasitic diseases Sequelae of unspecified infectious and parasitic disease

C15.3 C15.4 C15.5 C15.8 C15.9 C16.0 C16.1 C16.2 C16.3 C16.4 C16.5 C16.6 C16.8 C16.9 C17.0 C17.1 C17.2 C17.3 C17.8 C17.9 C18.0 C18.1 C18.2 C18.3 C18.4 C18.5 C18.6 C18.7 C18.8 C18.9 C19 C20 C21.0 C21.1 C21.2 C21.8 C22.0 C22.1 C22.2 C22.3 C22.4 C22.7

Malignant neoplasm of upper third of esophagus Malignant neoplasm of middle third of esophagus Malignant neoplasm of lower third of esophagus Malignant neoplasm of overlapping sites of esophagus Malignant neoplasm of esophagus, unspecified Malignant neoplasm of cardia Malignant neoplasm of fundus of stomach Malignant neoplasm of body of stomach Malignant neoplasm of pyloric antrum Malignant neoplasm of pylorus Malignant neoplasm of lesser curvature of stomach, unsp Malignant neoplasm of greater curvature of stomach, unsp Malignant neoplasm of overlapping sites of stomach Malignant neoplasm of stomach, unspecified Malignant neoplasm of duodenum Malignant neoplasm of jejunum Malignant neoplasm of ileum Meckel's diverticulum, malignant Malignant neoplasm of overlapping sites of small intestine Malignant neoplasm of small intestine, unspecified Malignant neoplasm of cecum Malignant neoplasm of appendix Malignant neoplasm of ascending colon Malignant neoplasm of hepatic flexure Malignant neoplasm of transverse colon Malignant neoplasm of splenic flexure Malignant neoplasm of descending colon Malignant neoplasm of sigmoid colon Malignant neoplasm of overlapping sites of colon Malignant neoplasm of colon, unspecified Malignant neoplasm of rectosigmoid junction Malignant neoplasm of rectum Malignant neoplasm of anus, unspecified Malignant neoplasm of anal canal Malignant neoplasm of cloacogenic zone Malig neoplasm of ovrlp sites of rectum, anus and anal canal Liver cell carcinoma Intrahepatic bile duct carcinoma Hepatoblastoma Angiosarcoma of liver Other sarcomas of liver Other specified carcinomas of liver

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