82270

Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations

CPT code 82270 represents the laboratory procedure for the qualitative detection of occult blood in a fecal sample, utilizing peroxidase activity (e.g., guaiac-based methods). This test is designed to identify the presence of hemoglobin in stool, which is indicative of gastrointestinal bleeding. The code covers 1-3 simultaneous determinations from the same patient, typically as part of a single screening or diagnostic episode. It is a non-invasive method used to screen for or investigate potential sources of bleeding within the gastrointestinal tract that may not be visibly apparent.

Clinical Indications

  • Screening for colorectal cancer in asymptomatic individuals at average risk, typically aged 45-75 years, as part of recommended screening guidelines.
  • Evaluation of unexplained iron deficiency anemia, which may suggest chronic gastrointestinal blood loss.
  • Investigation of symptoms suggestive of gastrointestinal bleeding, such as changes in bowel habits, abdominal pain, weight loss, or fatigue.
  • Monitoring patients with known gastrointestinal conditions (e.g., inflammatory bowel disease, diverticulosis, polyps) for the presence of active or intermittent bleeding.
  • Assessment of patients with a family history of colorectal cancer or polyps as part of a surveillance strategy (in conjunction with other tests).

Procedure Steps

  1. Patient receives instructions for collecting 1-3 fecal samples, often on consecutive days, avoiding certain foods or medications that may interfere with results.
  2. Collected fecal samples are applied by the patient or laboratory personnel to a specific test card or slide containing guaiac paper.
  3. The test card is submitted to the laboratory for analysis.
  4. A developing solution (e.g., hydrogen peroxide solution) is added to the guaiac-impregnated paper containing the fecal sample.
  5. If occult blood is present, the heme peroxidase activity catalyzes the oxidation of the guaiac, resulting in a color change (typically blue) within a specified timeframe.
  6. Results are interpreted as positive or negative based on the observed color change.

Coding Guidelines

  • Code 82270 is used for qualitative, guaiac-based fecal occult blood testing. It includes 1-3 simultaneous determinations for a single episode of care.
  • Do not report 82270 for immunochemical fecal occult blood tests (FIT); use CPT code 82274 for those assays.
  • If a patient performs multiple tests over several days as part of a complete screening protocol (e.g., a three-card test kit), 82270 is typically reported once per complete test series, not per individual test application, unless payer guidelines specify otherwise.
  • Medical necessity must be documented, including symptoms, signs, or adherence to established screening guidelines (e.g., for colorectal cancer screening).
  • This code is not typically bundled with E/M services when performed in an office setting, but laboratory services are generally billed separately by the performing laboratory.
  • For screening purposes, ensure that the patient meets the age and risk criteria specified by clinical guidelines (e.g., USPSTF, ACS).

Associated ICD-10 Codes