Pathology/Lab Coding Alert

Question: When a physician orders a screening FOBT test using diagnosis code v76.51 and the results are positive, should we change the diagnosis code to indicate blood in the stool, such as 569.3?

Louisiana Subscriber

Answer: No, you should not change the screening diagnosis code V76.51 (Special screening for malignant neoplasms; colon) to a diagnostic code.

The lab will report the test (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]) with the screening ordering diagnosis V76.51.

If the lab test is positive for occult blood, the ordering physician will assign a diagnosis based on lab and clinical findings. The most common diagnosis code for positive FOBT is 578.1 (Blood in stool). Physicians might also assign 792.1 (Nonspecific abnormal findings in other body substances; stool contents), but 578.1 is more specific for a positive FOBT. Occasionally the physician might assign 569.3 (Hemorrhage of rectum and anus) based on a positive FOBT and other clinical observations.

Diagnosis guides coverage: Most Medicare payers accept 578.1 as a diagnosis to support a colonoscopy. But many payers deny rectal bleeding (569.3) as a justification for a colonoscopy because they presume that the source of the bleeding is the rectum or anus, not the colon. Payers may accept rectal bleeding, however, as an acceptable diagnosis for a flexible sigmoidoscopy.