ICD-10 Coding for Positive Fecal Occult Blood Test(R19.5, Z12.11)
Complete ICD-10-CM coding and documentation guide for Positive Fecal Occult Blood Test. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Positive Fecal Occult Blood Test
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 when a fecal occult blood test returns a positive result, indicating potential gastrointestinal bleeding. |
|
| Z12.11 | Encounter for screening for malignant neoplasm of colon | Use as the primary code for colorectal cancer screening encounters. |
|
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 FOBT
Essential facts and insights about Positive Fecal Occult Blood Test
Primary ICD-10-CM Codes for positive fobt
Decision Criteria
clinical Criteria
- Positive lab result from FOBT or FIT
documentation Criteria
- Explicit mention of test type and result in medical record
Applicable To
- Positive fecal occult blood test
- Abnormal fecal immunochemical test
Clinical Validation Requirements
- Lab-confirmed positive FOBT or FIT result
- Documentation of test type and number of samples
Code-Specific Risks
- Incorrectly using R19.5 alone in screening contexts without Z12.11
Coding Notes
- Ensure documentation specifies test type (FIT or guaiac) and clinical context (screening vs. diagnostic).
Z12.11 - Encounter for screening for malignant neoplasm of colon
Use as the primary code for colorectal cancer screening encounters.
Applicable To
- Routine colorectal cancer screening
Excludes
- Diagnostic colonoscopy (CPT 45378)
Clinical Validation Requirements
- Patient is asymptomatic and undergoing routine screening
Coding Notes
Ensure screening context is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Positive Fecal Occult Blood Test to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R19.5.
Impact
Clinical: Misrepresentation of screening services, Regulatory: Non-compliance with preventive care guidelines, Financial: Potential claim denials for preventive services
Mitigation Strategy
Ensure Z12.11 is used for all screening encounters, Verify documentation supports screening context
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on screening outcomes.
Mitigation Strategy
Always pair with Z12.11 when asymptomatic.
Impact
Incorrectly coding diagnostic tests as screening can lead to audits.
Mitigation Strategy
Ensure proper documentation of clinical context and test indication.
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 Positive Fecal Occult Blood Test, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Positive Fecal Occult Blood Test
Use these documentation templates to ensure complete and accurate documentation for Positive Fecal Occult Blood Test. These templates include all required elements for proper coding and billing.
Routine Screening with Positive FIT
Specialty: Primary CareRequired Elements
- Patient demographics
- Screening indication
- Test type and result
- Follow-up plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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