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ICD-10 Guide
ICD-10 CodesK51.212

K51.212

Billable

Ulcerative (chronic) proctitis with intestinal obstruction

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

Code Description

ICD-10 K51.212 is a billable code used to indicate a diagnosis of ulcerative (chronic) proctitis with intestinal obstruction.

Key Diagnostic Point:

K51.212 refers to ulcerative (chronic) proctitis with intestinal obstruction, a condition characterized by inflammation and ulceration of the rectal mucosa. This disease primarily affects the rectum and can lead to significant discomfort, rectal bleeding, and changes in bowel habits. The chronic nature of ulcerative proctitis means that patients may experience recurrent episodes of inflammation, which can progressively worsen over time. The obstruction may occur due to severe inflammation, strictures, or complications such as abscess formation. Diagnosis typically involves a combination of clinical evaluation, endoscopic examination, and histological analysis of rectal biopsies. Patients may present with symptoms such as abdominal pain, tenesmus, and bloody diarrhea, which necessitate careful assessment to rule out other gastrointestinal disorders. Management often includes anti-inflammatory medications, immunosuppressants, and in severe cases, surgical intervention may be required to relieve obstruction and manage complications. Regular monitoring and follow-up are essential to prevent disease progression and maintain quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differentiation from other gastrointestinal disorders.
  • Treatment complexity: Involves a multidisciplinary approach including medical management and potential surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to capture the specific nature of the condition and its complications.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcerative proctitis severity or failure to document obstruction.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the patient's condition or treatment.
  • Billing challenges: Potential denials due to lack of supporting documentation for the complexity 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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

K51.212 has significant clinical implications as it affects a patient's quality of life and may lead to increased healthcare utilization due to recurrent flare-ups and complications. The condition is prevalent among certain populations, particularly young adults, and can lead to long-term health issues if not managed effectively. Understanding the epidemiology of ulcerative proctitis and its complications is essential for improving patient outcomes and implementing effective public health strategies.

ICD-9 vs ICD-10

K51.212 has significant clinical implications as it affects a patient's quality of life and may lead to increased healthcare utilization due to recurrent flare-ups and complications. The condition is prevalent among certain populations, particularly young adults, and can lead to long-term health issues if not managed effectively. Understanding the epidemiology of ulcerative proctitis and its complications is essential for improving patient outcomes and implementing effective public health strategies.

Reimbursement & Billing Impact

Reimbursement may be affected by the complexity of the case, and providers should be aware of common denial reasons, such as insufficient documentation or misclassification of the condition. Best practices include thorough documentation of all clinical encounters and ensuring that the coding accurately reflects the severity and complications of the condition.

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 K51.212?

K51.212 specifically covers chronic ulcerative proctitis that is complicated by intestinal obstruction. This includes cases where inflammation leads to strictures or other obstructive processes affecting the rectum.

When should K51.212 be used instead of related codes?

K51.212 should be used when there is clear documentation of chronic ulcerative proctitis accompanied by intestinal obstruction. If the obstruction is not present, other codes for ulcerative proctitis without obstruction should be considered.

What documentation supports K51.212?

Documentation should include a detailed history of symptoms, results from endoscopic evaluations, biopsy findings, and treatment plans that indicate the presence of intestinal obstruction along with the diagnosis of ulcerative proctitis.