Gastroenterology Coding Alert

Question: I'm not sure when I should use 569.3 and 578.1 for bloody stool. Are they one and the same?

Answer: No. When you examine the stool, you would be able to decide on the original source of the bleeding. Then, you'd be able to choose the appropriate ICD-9 code.

Blood in the stool usually originates from somewhere up the gastrointestinal tract. In this case, you would use 578.1 (Blood in stool). On the other hand, traces of bright red blood on the outside of the stool or on the toilet tissue usually occurs from a source within the rectum or anus (569.3, Hemorrhage of rectum and anus).

When coding for a colonoscopy (45378), you would usually report 578.1 with 792.1 (Nonspecific abnormal findings in stool contents). Some carriers don't accept rectal bleeding as a justifiable diagnosis for colonoscopy because they presume that the source of the bleeding is the rectum or anus, not the colon. However, they accept rectal bleeding 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]).

Hint: The gastroenterologist would opt for a colonoscopy if the flexible sigmoidoscopy does not reveal a source of the bleeding. The source could lie past the splenic flexure, which is only visible via a colonoscopy.