82274

Blood, occult, by fecal hemoglobin determination, by immunoassay, qualitative, 1-3 simultaneous determinations

CPT code 82274 describes a qualitative laboratory test that detects human occult blood in stool samples using an immunoassay method. This test, commonly known as a Fecal Immunochemical Test (FIT), specifically targets human hemoglobin, making it more specific for lower gastrointestinal bleeding compared to guaiac-based tests that can react with non-human peroxidases. The '1-3 simultaneous determinations' indicates that the service includes the analysis of one to three distinct stool samples collected from the patient over a period (e.g., consecutive days), which are then analyzed together or separately as part of a single testing event to enhance sensitivity for intermittent bleeding. The test provides a 'positive' or 'negative' result, indicating the presence or absence of human hemoglobin in the collected fecal matter. It is primarily used for screening for colorectal cancer and for evaluating symptoms suggestive of gastrointestinal bleeding.

Clinical Indications

  • Routine screening for colorectal cancer in asymptomatic individuals at average risk, as part of preventative health guidelines.
  • Evaluation of unexplained iron deficiency anemia, which may indicate chronic, occult gastrointestinal blood loss.
  • Investigation of gastrointestinal symptoms such as changes in bowel habits, abdominal pain, or unexplained weight loss, where occult bleeding is suspected.
  • Surveillance for recurrent disease or new adenomas in patients with a personal history of colorectal polyps or colorectal cancer, particularly when colonoscopy is not immediately indicated or feasible.
  • As an alternative screening method for colorectal cancer when colonoscopy is declined or contraindicated due to patient preference or medical comorbidities.

Procedure Steps

  1. A patient receives a take-home kit for stool collection, along with detailed instructions on how to collect samples.
  2. The patient collects a small sample of stool (usually from 1-3 separate bowel movements as instructed) using the provided collection device, which typically involves scraping the surface of the stool.
  3. The collected sample(s) are then sealed within the provided collection tube or applied to a specific card.
  4. The patient returns the collected sample(s) to the laboratory for analysis.
  5. In the laboratory, the collected sample(s) are processed using an immunoassay technique to specifically detect human hemoglobin.
  6. The test result is interpreted as positive or negative, indicating the presence or absence of occult blood.

Coding Guidelines

  • CPT code 82274 should be reported for the qualitative immunoassay detection of human fecal occult blood, covering 1-3 simultaneous determinations. This typically refers to a single testing event inclusive of multiple samples from one patient.
  • Do not report 82274 in conjunction with CPT code 82270 (Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations) for the same patient on the same date of service, as these are different methodologies for detecting fecal occult blood.
  • Medical necessity for the test must be clearly documented in the patient's medical record, indicating whether it is for screening purposes (e.g., colorectal cancer screening) or for diagnostic evaluation of symptoms.
  • For screening purposes, frequency limitations may apply based on payer policies (e.g., typically once per year for average-risk colorectal cancer screening).
  • If a positive result is obtained from a screening FIT test (82274), subsequent diagnostic procedures (e.g., colonoscopy) would be separately reported under their respective CPT codes.

Associated ICD-10 Codes