Letter Positive Test With Cologuard
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FAQ
Abnormal result (positive result) suggests that the test found some pre-cancer or cancer cells in your stool sample. However, the Cologuard test does not diagnose cancer. You will need further tests to make a diagnosis of cancer. Your provider will likely suggest a colonoscopy.
Common diagnosis codes for colorectal cancer screening include: Z12. 11 (encounter for screening for malignant neoplasm of colon)
Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by colonoscopy.
Once a patient has a positive Cologuard test, their colonoscopy is no longer considered a routine screening exam. Instead, the procedure must be reclassified as a diagnostic exam. Screening colonoscopies are frequently covered at 100% by many insurance companies. Diagnostic exams, however, are not.
11, followed by the positive Cologuard secondary ICD-10-CM diagnosis code R19. 5. It is recommended to report CPT code G0121 if the procedure stays screening or the appropriate therapeutic CPT with modifier PT.
