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ICD-10 Guide
ICD-10 CodesK51.011

K51.011

Billable

Ulcerative (chronic) pancolitis with rectal bleeding

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K51.011 is a billable code used to indicate a diagnosis of ulcerative (chronic) pancolitis with rectal bleeding.

Key Diagnostic Point:

K51.011 refers to ulcerative (chronic) pancolitis with rectal bleeding, a subtype of ulcerative colitis that affects the entire colon. This condition is characterized by inflammation and ulceration of the colonic mucosa, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding. The disease can progress from mild to severe, with potential complications including toxic megacolon and increased risk of colorectal cancer. Diagnosis typically involves a combination of clinical evaluation, endoscopic examination, and histological analysis of biopsy samples. Patients may present with varying degrees of symptoms, and the severity can fluctuate over time, necessitating ongoing monitoring and management. Treatment often includes anti-inflammatory medications, immunosuppressants, and in some cases, surgical intervention. Understanding the anatomy involved, including the rectum and entire colon, is crucial for effective management and coding of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation and differentiation from other gastrointestinal disorders.
  • Treatment complexity: Involves a multidisciplinary approach including gastroenterologists, nutritionists, and possibly surgeons.
  • Documentation requirements: Detailed clinical notes and diagnostic imaging are essential for accurate coding.
  • Coding specificity: Requires precise coding to reflect the severity and specific manifestations of the disease.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity or type of ulcerative colitis.
  • Documentation gaps: Incomplete clinical notes that do not fully capture the patient's condition.
  • Billing challenges: Potential denials due to lack of supporting documentation for the severity of the disease.

Specialty Focus

Medical Specialties

Primary medical specialty: Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Secondary specialty: Internal Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Ulcerative pancolitis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and the need for ongoing treatment. The condition is prevalent in various populations, with varying incidence rates globally. Effective management is crucial for reducing complications and improving health outcomes, making it a key focus for quality measures in gastroenterology.

ICD-9 vs ICD-10

Ulcerative pancolitis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and the need for ongoing treatment. The condition is prevalent in various populations, with varying incidence rates globally. Effective management is crucial for reducing complications and improving health outcomes, making it a key focus for quality measures in gastroenterology.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for certain treatments and procedures, especially if surgical intervention is required. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the patient's diagnosis and treatment plan.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K51.011?

K51.011 specifically covers chronic ulcerative pancolitis with rectal bleeding, which is a severe form of ulcerative colitis affecting the entire colon and characterized by significant inflammation and ulceration leading to rectal bleeding.

When should K51.011 be used instead of related codes?

K51.011 should be used when the patient has a confirmed diagnosis of chronic ulcerative pancolitis with rectal bleeding, differentiating it from other forms of ulcerative colitis that may not involve the entire colon or present with bleeding.

What documentation supports K51.011?

Documentation should include clinical findings, endoscopic reports, biopsy results, and a detailed history of symptoms, particularly the presence of rectal bleeding and the extent of colonic involvement.