Pathology/Lab Coding Alert

Question: When a physician orders a screening FOBT test due to blood in the stool, is the appropriate diagnosis code 569.3 or 578.1?

Arkansas Subscriber

Answer: Neither diagnosis code you listed is appropriate for a screening fecal occult blood test (FOBT). Both of the codes indicate a sign or symptom that would warrant a diagnostic test, not a cancer screening:

• 578.1 -- Blood in stool
• 569.3 -- Hemorrhage of rectum and anus.

The physician might assign one of these codes based on clinical findings. For instance, the patient may report black, tarry stool indicating blood that originates somewhere in the upper gastrointestinal tract (578.1), or bright red blood on the stool surface indicating bleeding in the rectum or anus (569.3).

If the patient presents with no symptoms and the physician orders an FOBT test to screen for colorectal cancer (such as 82270, Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [i.e., patient was provided 3 cards or single triple card for consecutive collection]), the physician should order the test with ICD-9 code V76.51 (Special screening for malignant neoplasms; colon).