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ICD-10 Guide
ICD-10 CodesK51.012

K51.012

Billable

Ulcerative (chronic) pancolitis with intestinal obstruction

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

Code Description

ICD-10 K51.012 is a billable code used to indicate a diagnosis of ulcerative (chronic) pancolitis with intestinal obstruction.

Key Diagnostic Point:

K51.012 refers to ulcerative (chronic) pancolitis with intestinal obstruction, a severe form of inflammatory bowel disease (IBD) that affects the entire colon. Clinically, patients present with symptoms such as abdominal pain, bloody diarrhea, and urgency to defecate, often accompanied by systemic symptoms like fever and weight loss. The anatomy involved includes the colon, which becomes inflamed and ulcerated, leading to complications such as strictures and obstruction. Disease progression can vary, with periods of exacerbation and remission. Chronic inflammation can lead to complications like toxic megacolon or colorectal cancer. Diagnostic considerations include colonoscopy with biopsy to confirm the diagnosis and assess the extent of the disease. Imaging studies, such as CT scans, may be utilized to evaluate for obstruction and other complications. Early diagnosis and management are crucial to prevent severe complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differential diagnosis to rule out other causes of colitis.
  • Treatment complexity: Involves a multidisciplinary approach including medication management, potential surgery, and ongoing monitoring.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to capture the specific type of ulcerative colitis and associated complications.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcerative colitis types or failure to document obstruction.
  • Documentation gaps: Incomplete clinical notes regarding the extent of disease and treatment response.
  • Billing challenges: Potential denials due to lack of supporting documentation for the severity of the condition.

Specialty Focus

Medical Specialties

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

Colorectal Surgery

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

K51.012 has significant clinical implications, as ulcerative pancolitis can lead to severe complications, impacting patient quality of life and healthcare utilization. The condition is prevalent in certain populations, necessitating effective management strategies to reduce hospitalizations and improve health outcomes. Understanding the epidemiology of ulcerative colitis aids in developing targeted interventions and quality measures to enhance patient care.

ICD-9 vs ICD-10

K51.012 has significant clinical implications, as ulcerative pancolitis can lead to severe complications, impacting patient quality of life and healthcare utilization. The condition is prevalent in certain populations, necessitating effective management strategies to reduce hospitalizations and improve health outcomes. Understanding the epidemiology of ulcerative colitis aids in developing targeted interventions and quality measures to enhance patient care.

Reimbursement & Billing Impact

Reimbursement may be affected by the severity of the condition and the complexity of treatment. Common denials can occur if documentation does not clearly support the diagnosis of ulcerative pancolitis with obstruction. It is essential to include all relevant clinical findings, treatment plans, and follow-up care in the medical record to ensure proper reimbursement and minimize audit risks.

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 K51.012?

K51.012 covers chronic ulcerative pancolitis with intestinal obstruction, characterized by inflammation and ulceration of the entire colon, leading to complications such as strictures and bowel obstruction.

When should K51.012 be used instead of related codes?

K51.012 should be used when the patient has documented chronic ulcerative pancolitis specifically with intestinal obstruction, differentiating it from other forms of ulcerative colitis without obstruction.

What documentation supports K51.012?

Documentation should include clinical notes detailing the patient's symptoms, diagnostic imaging results, colonoscopy findings, and any treatment plans addressing the obstruction and inflammation.