Gastroenterology Coding Alert

Question: When should we use 569.3 and 578.1 for bloody stool?


New Hampshire Subscriber

Answer: You need to decide on the bleeding's original source, which you can frequently determine from examining the stool.

Blood in the stool usually derives from somewhere up the gastrointestinal tract, so you would use 578.1 (Blood in stool). On the other hand, blood on the outside of the stool or only on the tissue paper usually occurs from a source within the rectum or anus (569.3, Hemorrhage of rectum and anus).

Although most Medicare carriers accept 578.1 with 792.1 (Occult or concealed blood in stool) as diagnoses to support a colonoscopy (45378), some carriers deny rectal bleeding as a justifiable diagnosis because they presume that the source of the bleeding is the rectum or anus, not the colon. They do accept rectal bleeding, however, as an acceptable diagnosis for a flexible sigmoidoscopy (45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). 

When the flexible sigmoidoscopy does not reveal a source of the bleeding, you have good reason for a colonoscopy because the source could lie past the splenic flexure, which is not visible during a flexible sigmoidoscopy.