ICD-10 Code for FOBT Screening
For asymptomatic adults undergoing routine FOBT screening for colorectal cancer, use ICD-10 code Z12.11 (Encounter for screening for malignant neoplasm of colon).
Primary Screening Code
Z12.11 is the appropriate ICD-10 code for colorectal cancer screening encounters in asymptomatic average-risk adults aged 50 and older undergoing FOBT 1, 2
This code applies when the patient has no signs, symptoms, or personal history of colorectal cancer and is presenting specifically for preventive screening 1
Clinical Context for Proper Coding
Age-appropriate screening parameters:
Standard screening begins at age 50 for average-risk individuals and continues through age 75 1, 2
Annual FOBT is the recommended screening interval for both guaiac-based (gFOBT) and fecal immunochemical tests (FIT) 1, 2
For ages 76-85, screening decisions should be individualized based on prior screening history and life expectancy, but Z12.11 remains appropriate when screening is performed 1
Important coding distinctions:
Z12.11 should only be used for true screening in asymptomatic patients 1
If the patient has gastrointestinal symptoms (bleeding, anemia, abdominal pain, change in bowel habits), this is diagnostic testing, not screening, and symptom-specific codes should be used instead 3
Single-sample FOBT obtained during digital rectal examination in the office should not be coded as screening because it is not an acceptable screening test with sensitivity of only 4.9% for advanced neoplasia 4
Follow-up Coding Considerations
When FOBT is positive:
The follow-up colonoscopy should be coded as diagnostic (not screening) because it is investigating an abnormal finding 4
Any positive FOBT requires colonoscopy within 60 days; repeating the FOBT is inappropriate 2, 4
Approximately 10% of positive FOBTs will reveal colorectal cancer and 37% will show adenomatous polyps on subsequent colonoscopy 5
Critical implementation requirements:
Home-based specimen collection with 3 stool samples is required for proper FOBT screening 4
High-sensitivity gFOBT (such as Hemoccult SENSA) should be used rather than older, lower-sensitivity versions 1, 2
Patients must understand that annual testing is necessary to achieve the mortality reduction benefit of FOBT screening 1, 2