Coding Tip of the Month – June 2019

Cologuard® was approved by the FDA in August 2014 and is an easy to use, noninvasive colon cancer screening test that identifies altered DNA and/or blood in stool, which are associated with the possibility of colon cancer or precancer. DNA is continuously shed from cells in the intestinal lining and passed into the stool. Both precancer and cancer shed DNA, so it can be an early indicator of the presence of colon cancer or precancerous lesions, before altered DNA would be present in the blood stream.

A positive result does not necessarily mean that you have cancer. It means that Cologuard® detected DNA and/or hemoglobin biomarkers in the stool which are associated with colon cancer or precancer. False positives and false negatives occur with Cologuard® and appropriate follow-up is important. Patients with a positive result should have a diagnostic colonoscopy. Patients with a negative diagnostic colonoscopy following a positive Cologuard® result do not require additional clinical evaluation.

When a patient is referred for a colonoscopy due to a positive Cologuard® test, the principal diagnosis will be selected and assigned based on the results of the diagnostic colonoscopy. If the colonoscopy demonstrates no abnormal findings, assign the code: R19.5 Other fecal abnormalities. Conversely, if the results of the diagnostic colonoscopy reveal a benign or malignant growth with or without removal, assign the code for the specific growth or condition diagnosed during the procedure. For example, if a cecal polyp is found and removed, assign the code K63.5 Polyp of colon. When a colonoscopy is performed due to a positive finding on a Cologuard® test, the colonoscopy would be considered a diagnostic examination, not a screening.

Reference: AHA Coding Clinic First Quarter 2019 (pages 32 – 33)

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