Gastroenterology Coding Alert

Question: When should we use 569.3 (Hemorrhage of rectum and anus) and 578.1 (Blood in stool) for
bloody stool?

New Hampshire Subscriber
 


Answer: You need to decide on the original source of the bleeding, 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. On the other hand, blood on the outside of the stool usually occurs from a source within the rectum or anus (569.3).

Although most Medicare carriers accept 578.1 with 792.1 (Occult or concealed blood in stool) as diagnoses for 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).
 
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 in a flexible sigmoidoscopy.