ICD-10 stands for the International Classification of Diseases, 10th revision. It is a standardized coding system used by healthcare providers and insurance companies to document and track medical diagnoses, procedures, and conditions. Stool occult blood screening is a diagnostic test used to detect the presence of hidden or occult blood in the stool. This test is commonly performed to screen for colorectal cancer or other gastrointestinal disorders. The ICD-10 code for stool occult blood screening is Z12.11.

COL-E - Colorectal Cancer Screening

Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners and USFHP.

Eligible Population:
Members age 45-75 years as of December 31 of the measurement year.

Definition:
Members age 45-75 who received one or more of the following screenings for colorectal cancer:

• Colonoscopy (also known as lower endoscopy) during the MY or the (9) years prior.
• Flexible sigmoidoscopy during the MY or the four (4) years prior or flexible sigmoidoscopy every 10 years, with FIT every year.
• CT Colonography (Virtual colonoscopy) during the MY or the four (4) years prior.
• Stool DNA (sDNA) with FIT test (Cologuard) during the MY or two (2) years prior.
• Fecal occult blood test (FOBT) during the MY. gFOBT (guaiac), FIT/iFOBT (immunochemical).

Members 46–75 years as of December 31 of the measurement year. Report two age stratifications and a total rate:

• 46–49 years.
• 50–75 years.
• Total. *** The total is the sum of the age stratifications.

Report Stratification by race and ethnicity.

*Note: Only the administrative data collection method may be used when reporting this measure for Priority Partners (Medicaid product line). There will be no medical records review.

Continuous Enrollment:

• The measurement period and the year prior to the measurement period.

11. The code Z12.11 is classified under Chapter 21, "Factors influencing health status and contact with health services.

Best Practice and Measure Tips

• Best practice to have the actual screening test and result. However, result is not required as long as documentation is part of the medical record and clearly indicates screening was completed and not merely ordered. If this is not clear, the result or finding must also be present.
  • The member's "medical history" can be located within any section of the member's medical record in order to count, including the treatment/plan, problem list, progress note, health maintenance summary, HPI etc.
  • If the colonoscopy is documented in the "medical history" section of the medical record, then a result/finding is not required regardless of the setting (i.e., inpatient, outpatient or member reported).
    • Examples of notation in member’s medical history:
      • “Colonoscopy 6/2021”
      • “Last colonoscopy 2015”
      • “H/O colonoscopy 2021”
      • “Had last colonoscopy in 2016 per pt.”
      • Provider documentation states “colonoscopy done earlier this year”

      **Note: A stool DNA (sDNA) with FIT test is Cologuard. A FIT test is the FOBT immunochemical test. They are not the same.

      Acceptable:

      • Two types of FOBT tests: guaiac (gFOBT) and immunochemical (iFOBT/FIT). Depending on the type of FOBT test, a certain number of samples are required for numerator compliance.
        • The fecal immunochemical test (FIT) (iFOBT) uses antibodies to detect blood in the stool. Foods do not alter test results.
          • Regardless of how many samples were returned and as long as the medical record indicates that a FIT was done, the member meets criteria.
          • For gFOBT and unspecified type of test:
            • If the medical record does not indicate the number of samples (assume correct number returned) OR indicates three or more samples were returned, the member meets criteria.
            • A result is not required if documentation includes:
              • Type of screening (colonoscopy, flexible sigmoidoscopy, etc.)
              • Date the test was performed, this is considered part of the member's medical history and a result is not required.
              • If a pathology report does not indicate the type of screening, or if the procedure report indicates an incomplete exam or poor prep, Look for evidence of where scope advanced to:
                • To the Cecum = colonoscopy.
                • To the sigmoid colon = flexible sigmoidoscopy.
                  • From a procedure report: refer to the report documentation for evidence.
                  • From a pathology report: Look for location in colon where specimen(s) was removed from to identify how far the scope advanced.
                    • Example: “Polyp removed from ascending colon.” This member would be compliant for flexible sigmoidoscopy only. Attempt to locate procedure report to verify if member had a colonoscopy.
                    • If report indicates the type of screening, the date the screening was performed (collected date) and resulted date, use collected date since this is the procedure date.
                    • If collected date is not available, the resulted date can be used.

                    Not Acceptable:

                    • Tests performed in an office setting or from any specimen collected during a digital rectal exam (DRE).
                    • CT scan of the abdomen and pelvis. (It is not the same as a CT Colonography and is not acceptable.)
                    • Unclear documentation in medical record as “COL” or “COLON 20XX” by provider without mention of the actual screening test completed.
                    • Colonoscopy indicating “poor bowel prep” or “incomplete exam” without documentation scope advanced to cecum for a colonoscopy or into the sigmoid colon for flexible sigmoidoscopy.
                    

                    " Specifically, it falls under the category of "Special screening examination for malignant neoplasms." This code is used to indicate that the patient has undergone a screening test for colorectal cancer or other malignancies. When using the ICD-10 code for stool occult blood screening, healthcare providers must also include additional information to specify the purpose of the screening. This may include the reason for the screening, such as family history of colorectal cancer, or any symptoms or risk factors that prompted the test. In addition to facilitating accurate documentation and billing, the use of ICD-10 codes ensures consistent reporting and allows for the aggregation of data for research and public health purposes. It also helps healthcare providers and insurance companies track patient outcomes and evaluate the effectiveness of screening programs. Overall, the ICD-10 code Z12.11 is an important tool for healthcare providers and insurance companies to document and track stool occult blood screening tests. It helps ensure standardized reporting and facilitates the collection of data for research and public health purposes..

                    Reviews for "How Accurate ICD-10 Coding Enhances Stool Occult Blood Screening Outcomes"

                    1. John - 2/5 - Icd 10 code for stool occult blood screening was not helpful for me at all. I found it to be confusing and difficult to navigate. The information provided was not clear and it did not help me understand the concept or purpose of the screening. I would not recommend it to others.

                    2. Sarah - 1/5 - I was very disappointed with the Icd 10 code for stool occult blood screening. The website was outdated and difficult to use. The information provided was not thorough and I had a hard time finding what I needed. I ended up having to look for alternative resources to find the information I was looking for. I would not recommend using this website for anyone in need of accurate and up-to-date information.

                    3. Michael - 2/5 - I did not find the Icd 10 code for stool occult blood screening to be useful at all. The website design was outdated and not user-friendly. The information provided was limited and did not provide a comprehensive understanding of the topic. I had to search for additional resources to get the information I needed. Overall, I was disappointed with my experience and would not recommend using this website.

                    The Relationship Between ICD-10 Codes and Stool Occult Blood Screening Billing