ICD-10-CM Coding for FOBT Screening
For fecal occult blood test (FOBT) performed as colorectal cancer screening in average-risk, asymptomatic adults, use ICD-10-CM code Z12.11 (Encounter for screening for malignant neoplasm of colon).
Coding Rationale
Z12.11 is the appropriate screening code when FOBT is performed for colorectal cancer screening in asymptomatic patients without signs, symptoms, or personal history of colorectal disease 1.
This code applies to all stool-based screening tests including high-sensitivity guaiac FOBT (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA tests when used for screening purposes 1.
When to Use This Code
Patient must be asymptomatic with no gastrointestinal symptoms, no prior colorectal cancer, no adenomatous polyps, and no inflammatory bowel disease 1.
Screening age range: Adults aged 45-75 years for routine screening, with individualized decisions for ages 76-85 years 1.
Annual screening intervals are recommended for both high-sensitivity gFOBT and FIT 1.
Critical Coding Pitfalls to Avoid
Do NOT use Z12.11 if the patient has symptoms (such as rectal bleeding, abdominal pain, change in bowel habits, or anemia). In symptomatic patients, code the presenting symptom instead (e.g., R19.5 for abnormal fecal contents, K62.5 for gastrointestinal hemorrhage) 1.
Do NOT use Z12.11 for surveillance testing in patients with prior polyps or colorectal cancer history. These patients require different codes based on their specific history 1.
Do NOT use Z12.11 for diagnostic FOBT ordered to evaluate an abnormal finding or follow up a positive screening test. The diagnostic indication should be coded instead 1.
Additional Coding Considerations
For high-risk patients (family history of colorectal cancer, Lynch syndrome, familial adenomatous polyposis), Z12.11 may still be appropriate for the screening encounter, but consider adding secondary codes for family history (Z80.0) or genetic susceptibility (Z15.09) to document increased risk 1.
Insurance coverage typically requires Z12.11 for preventive screening benefits to apply, as this designates the service as screening rather than diagnostic 1.