ICD-10 Coding for Abnormal Cologuard(R19.5, Z12.11, K63.5)
Complete ICD-10-CM coding and documentation guide for Abnormal Cologuard. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Abnormal Cologuard
R19-R19.9Primary Range
Symptoms and signs involving the digestive system and abdomen
This range includes codes for fecal abnormalities, which are relevant for abnormal Cologuard results.
Encounter for screening for malignant neoplasms
This range includes codes for screening encounters, relevant for follow-up procedures after a positive Cologuard.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R19.5 | Other fecal abnormalities | Use as the primary code for colonoscopy following a positive Cologuard result in asymptomatic patients. |
|
| Z12.11 | Encounter for screening for malignant neoplasm of colon | Use as a secondary code when the colonoscopy is part of a screening process. |
|
| K63.5 | Polyp of colon | Use as primary if a polyp is found during colonoscopy following a positive Cologuard. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for abnormal Cologuard
Essential facts and insights about Abnormal Cologuard
Primary ICD-10-CM Codes for abnormal cologuard
Decision Criteria
clinical Criteria
- Positive Cologuard result documented
coding Criteria
- Use R19.5 as primary for asymptomatic follow-up
Applicable To
- Positive Cologuard result
Excludes
- R85.89 (Abnormal tumor markers)
Clinical Validation Requirements
- Documented positive Cologuard test result
- Reason for colonoscopy explicitly linked to positive Cologuard
Code-Specific Risks
- Incorrectly using R85.89 instead of R19.5
Coding Notes
- Ensure documentation specifies 'positive Cologuard' and links to the need for colonoscopy.
Z12.11 - Encounter for screening for malignant neoplasm of colon
Use as a secondary code when the colonoscopy is part of a screening process.
Applicable To
- Routine colon cancer screening
Clinical Validation Requirements
- Patient is asymptomatic
- Colonoscopy is part of routine screening
Coding Notes
Ensure the screening context is documented.
K63.5 - Polyp of colon
Use as primary if a polyp is found during colonoscopy following a positive Cologuard.
Applicable To
- Colonic polyp found during colonoscopy
Clinical Validation Requirements
- Polyp confirmed during colonoscopy
Coding Notes
Ensure biopsy results confirm polyp.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening for malignant neoplasm of colon
Z12.11Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Abnormal Cologuard to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R19.5.
Impact
Clinical: May lead to inappropriate follow-up care., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Use specific test names and dates, Link test results to follow-up procedures
Impact
Reimbursement: May lead to claim denials or incorrect reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use R19.5 for fecal abnormalities related to positive Cologuard.
Impact
Using incorrect codes for colonoscopy after positive Cologuard.
Mitigation Strategy
Ensure R19.5 is used as primary with appropriate modifiers.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Abnormal Cologuard, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Abnormal Cologuard
Use these documentation templates to ensure complete and accurate documentation for Abnormal Cologuard. These templates include all required elements for proper coding and billing.
Normal colonoscopy after positive Cologuard
Specialty: GastroenterologyRequired Elements
- Positive Cologuard test result
- Date of test
- Colonoscopy findings
- Symptom status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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