General Surgery Coding Alert

Question: What is the difference between ICD-9 codes 569.3 (hemorrhage of rectum and anus) and 578.1?

Arizona Subscriber

Answer: The main difference between the two codes is the original source of the bleeding, says M. Trayser Dunaway, MD, a general surgeon in Camden, S.C. When a patient has blood in the stool, the source of the bleeding is usually somewhere upstream, in the gastrointestinal tract. When the source of the bleeding is the rectum or anus, the blood would not typically be inside the stool, but rather would visibly coat the outside.

The difference between the two diagnoses can affect payment. Most local Medicare carriers accept 578.1 (blood in stool; melena) with 792.1 (occult or concealed blood in stool) as justifiable diagnoses for a colonoscopy (45378). For some carriers, however, rectal bleeding may not justify colonoscopy (because the source of the bleeding presumptively is the rectum or anus, not the colon) but is an acceptable diagnosis for a flexible sigmoidoscopy (45330). If the flexible sigmoidoscopy cannot reveal the source of bleeding, Dunaway notes, there is a strong argument for colonoscopy because the source could be beyond the splenic flexure which cannot be seen by flexible sigmoidoscopy.