ICD-10 Code for Cologuard Test
For a positive Cologuard test result in an asymptomatic adult undergoing colorectal cancer screening, use ICD-10 code R19.5 (other fecal abnormalities). 1
Coding for Screening Context
Z12.11 is the appropriate ICD-10 code for the initial colorectal cancer screening encounter when ordering Cologuard for an asymptomatic average-risk patient 2
This code indicates "encounter for screening for malignant neoplasm of colon" and should be used when the test is ordered as part of routine screening 2
Coding After a Positive Result
R19.5 (other fecal abnormalities) should be assigned once a Cologuard test returns positive, as this code specifically captures abnormal stool-based test results 1
Timely assignment of the R19.5 code within 30-90 days of a positive result is associated with significantly improved colonoscopy completion rates (40.9% vs 16.8%, P <0.001) 1
This coding practice facilitates appropriate follow-up colonoscopy, which is mandatory after any positive Cologuard result 2, 3
Critical Coding Pitfall to Avoid
Do not use K92.1 (melena) for positive Cologuard results unless the patient has actual clinical evidence of melena, as this represents a different clinical scenario requiring diagnostic rather than screening evaluation 4
Less than two-thirds of patients receive appropriate ICD-10 code designation within 30 days of an abnormal result, which delays necessary follow-up colonoscopy 1