ICD-10 Coding for Cologuard® Stool DNA Testing(Z12.11, R19.5, C18.9)
Complete ICD-10-CM coding and documentation guide for Cologuard® Stool DNA Testing. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cologuard® Stool DNA Testing
Z12-Z13Primary Range
Encounter for screening for malignant neoplasms
This range includes codes for screening procedures, including colorectal cancer screening.
Other symptoms and signs involving the digestive system and abdomen
This range includes codes for abnormal findings in stool tests, such as a positive Cologuard® result.
Malignant neoplasms of the colon, rectosigmoid junction, and rectum
This range includes codes for confirmed colorectal cancer diagnoses following a positive screening result.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z12.11 | Encounter for screening for malignant neoplasm of colon | Use for asymptomatic patients undergoing screening colonoscopy. |
|
| R19.5 | Other fecal abnormalities | Use when Cologuard® test is positive and patient is asymptomatic. |
|
| C18.9 | Malignant neoplasm of colon, unspecified | Use when colorectal cancer is confirmed post-colonoscopy. |
|
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 positive Cologuard test
Essential facts and insights about Cologuard® Stool DNA Testing
Primary ICD-10-CM Codes for cologuard
Decision Criteria
clinical Criteria
- Patient must be asymptomatic for screening code use.
Applicable To
- Screening colonoscopy
Excludes
- Diagnostic colonoscopy
Clinical Validation Requirements
- Patient is asymptomatic
- Documentation states 'average-risk screening'
- No personal/family history of CRC
Code-Specific Risks
- Using for symptomatic patients
Coding Notes
- Ensure documentation specifies 'screening intent' to justify use.
R19.5 - Other fecal abnormalities
Use when Cologuard® test is positive and patient is asymptomatic.
Applicable To
- Positive Cologuard® test
Excludes
- Normal stool findings
Clinical Validation Requirements
- Cologuard® report showing 'positive for hemoglobin/DNA markers'
- No concurrent diarrhea/menstruation
Coding Notes
Ensure documentation specifies 'positive Cologuard® test'.
C18.9 - Malignant neoplasm of colon, unspecified
Use when colorectal cancer is confirmed post-colonoscopy.
Applicable To
- Confirmed colorectal cancer
Excludes
- Benign neoplasms
Clinical Validation Requirements
- Pathology confirming adenocarcinoma
- Localization (e.g., ascending colon)
Coding Notes
Ensure pathology report is available to support code use.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other fecal abnormalities
R19.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cologuard® Stool DNA Testing to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z12.11.
Impact
Clinical: May lead to inappropriate follow-up procedures., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or audits.
Mitigation Strategy
Specify test type and result in documentation, Use standardized phrases like 'positive Cologuard® test'
Impact
Reimbursement: May result in claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on screening vs. diagnostic procedures.
Mitigation Strategy
Use symptom-specific codes like K92.1 for melena.
Impact
Reimbursement: Potential denial of Medicare claims., Compliance: Non-compliance with CMS guidelines., Data Quality: Inaccurate reporting of screening procedures.
Mitigation Strategy
Append KX to G0121/G0105 for compliance.
Impact
Incorrectly coding diagnostic procedures as screenings.
Mitigation Strategy
Ensure documentation clearly states screening intent and patient symptom status.
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 Cologuard® Stool DNA Testing, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cologuard® Stool DNA Testing
Use these documentation templates to ensure complete and accurate documentation for Cologuard® Stool DNA Testing. These templates include all required elements for proper coding and billing.
Positive Cologuard® Test Follow-up
Specialty: GastroenterologyRequired Elements
- Patient demographics
- Screening intent
- Cologuard® test result
- Follow-up plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Cologuard® Stool DNA Testing? Ask your questions below.