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R19.6
ICD-10-CM
Positive Cologuard Test

Understanding a positive Cologuard test result? This guide covers Cologuard positive, colon cancer screening, fecal immunochemical test FIT, DNA stool test, colorectal cancer diagnosis, diagnostic colonoscopy, CPT codes for colonoscopy, ICD-10 code for positive Cologuard, and clinical documentation requirements for positive Cologuard. Learn about next steps after a positive Cologuard, including follow-up procedures and medical coding guidelines for accurate healthcare reimbursement.

Also known as

Positive Stool DNA Test
Positive FIT-DNA Test
cologuard screening positive

Diagnosis Snapshot

Key Facts
  • Definition : Detects altered DNA and blood in stool, suggesting possible colon cancer or precancerous polyps.
  • Clinical Signs : Often asymptomatic. May include blood in stool, changes in bowel habits, abdominal pain, or unexplained weight loss.
  • Common Settings : Primary care clinics, gastroenterology offices, and telehealth consultations for colorectal cancer screening.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC R19.6 Coding
R19.5

Other fecal abnormalities

Indicates abnormal findings in stool analysis, including blood.

Z12.11

Encounter for screening for colorectal cancer

Represents a healthcare visit specifically for colorectal cancer screening.

C18.-

Malignant neoplasm of colon

Used if Cologuard leads to a confirmed colon cancer diagnosis.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the positive Cologuard test confirmed by colonoscopy?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Positive Cologuard Test
Colorectal cancer
Advanced adenoma

Documentation Best Practices

Documentation Checklist
  • Cologuard positive: Document patient symptoms.
  • Positive Cologuard: Note date of test, result details.
  • Document reason for Cologuard, risk factors (age, family history).
  • Cologuard positive: Plan for colonoscopy documented.
  • ICD-10 R19.5, CPT 81528: Cologuard diagnostic coding documented.

Mitigation Tips

Best Practices
  • Code Z12.11 for positive Cologuard, follow up colonoscopy.
  • Document reason for Cologuard, patient symptoms, risk factors.
  • Ensure compliance with screening guidelines, payer coverage.
  • Timely referral for diagnostic colonoscopy post positive result.
  • Educate patient on next steps, importance of colonoscopy.

Clinical Decision Support

Checklist
  • Verify positive Cologuard result in EMR.
  • Confirm patient demographics and test order.
  • Document patient informed of positive result.
  • Schedule diagnostic colonoscopy per guidelines.
  • Code diagnosis and procedure appropriately (ICD-10).

Reimbursement and Quality Metrics

Impact Summary
  • **Reimbursement and Quality Metrics Impact Summary: Positive Cologuard Test**
  • **Keywords:** Cologuard billing, CPT 81528 reimbursement, CRC screening compliance, HEDIS colorectal cancer screening
  • **Impacts:**
  • Increased colonoscopy referrals, impacting facility resource utilization.
  • Improved CRC screening rates, positively affecting HEDIS quality scores.
  • Potential for earlier CRC diagnosis, reducing long-term healthcare costs.
  • Accurate coding (CPT 81528) crucial for appropriate reimbursement.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Cologuard positive: G0389
  • Document reason for Cologuard
  • Dx positive: Follow with colonoscopy
  • Check LCDs for coverage details
  • Positive Cologuard: Z12.11

Documentation Templates

Patient presents today following a positive Cologuard test result.  The patient reports no specific gastrointestinal complaints, such as abdominal pain, rectal bleeding, change in bowel habits, or unexplained weight loss.  Past medical history includes hypertension and hyperlipidemia, managed with lisinopril and atorvastatin, respectively.  Family history is negative for colorectal cancer.  Surgical history is significant for cholecystectomy.  The patient is a never-smoker and denies alcohol use.  Physical examination reveals a soft, non-tender abdomen with normal bowel sounds.  Rectal exam was unremarkable.  Given the positive Cologuard result, indicative of the presence of altered DNA andor hemoglobin in the stool sample, a diagnostic colonoscopy is recommended and scheduled to evaluate for colorectal cancer, polyps, or other colorectal pathologies.  Pre-procedure instructions for colonoscopy preparation were reviewed with the patient.  Risks, benefits, and alternatives to colonoscopy were discussed, and informed consent was obtained.  The importance of colon cancer screening and early detection was emphasized.  This positive Cologuard finding necessitates further evaluation, and the results of the colonoscopy will guide subsequent management, including potential biopsy, polypectomy, or referral to gastroenterology or oncology if indicated.  ICD-10 code R19.5 (Other fecal abnormalities) may be considered for billing purposes until a definitive diagnosis is established following colonoscopy.  CPT codes for the colonoscopy and any associated procedures will be determined at the time of the procedure.  Follow-up appointment scheduled post-colonoscopy to discuss findings and plan.