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ICD-10 Guide
ICD-10 CodesK51.211

K51.211

Billable

Ulcerative (chronic) proctitis with rectal bleeding

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

Code Description

ICD-10 K51.211 is a billable code used to indicate a diagnosis of ulcerative (chronic) proctitis with rectal bleeding.

Key Diagnostic Point:

K51.211 refers to ulcerative (chronic) proctitis with rectal bleeding, a subtype of ulcerative colitis that primarily affects the rectum. Clinically, patients may present with symptoms such as rectal bleeding, diarrhea, abdominal pain, and urgency to defecate. The condition is characterized by inflammation and ulceration of the rectal mucosa, which can lead to significant discomfort and complications if left untreated. The anatomy involved includes the rectum and surrounding tissues, which may become inflamed and ulcerated due to the autoimmune response associated with ulcerative colitis. Disease progression can vary, with some patients experiencing intermittent flare-ups and others having a more chronic course. Diagnostic considerations include colonoscopy with biopsy to confirm the diagnosis and assess the extent of inflammation. Laboratory tests may also be utilized to rule out other gastrointestinal conditions and to monitor for anemia due to blood loss.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and exclusion of other conditions.
  • Treatment complexity: May involve medication management, dietary changes, and in some cases, surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of ulcerative colitis.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcerative proctitis types.
  • Documentation gaps: Incomplete records regarding the severity and frequency of symptoms.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

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

Primary Care

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 proctitis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent flare-ups and complications. It is essential for population health as it affects a notable percentage of individuals with inflammatory bowel disease. Quality measures focus on symptom management and monitoring for potential complications, emphasizing the need for effective treatment strategies and patient education.

ICD-9 vs ICD-10

Ulcerative proctitis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent flare-ups and complications. It is essential for population health as it affects a notable percentage of individuals with inflammatory bowel disease. Quality measures focus on symptom management and monitoring for potential complications, emphasizing the need for effective treatment strategies and patient education.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear clinical evidence of the condition, including symptomatology and treatment history. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring that all clinical notes are thorough and that any diagnostic tests performed are clearly linked to the diagnosis.

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 K51.211?

K51.211 specifically covers chronic ulcerative proctitis with rectal bleeding, characterized by inflammation and ulceration of the rectal mucosa. It is important to differentiate this from other types of ulcerative colitis and gastrointestinal bleeding conditions.

When should K51.211 be used instead of related codes?

K51.211 should be used when the patient presents with chronic ulcerative proctitis specifically accompanied by rectal bleeding. If rectal bleeding is absent, K51.21 should be used instead.

What documentation supports K51.211?

Documentation should include clinical findings such as rectal bleeding, results from colonoscopy and biopsy, and any relevant laboratory tests. Detailed notes on symptom duration, severity, and treatment response are also critical.