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ICD-10 Guide
ICD-10 CodesK51.31

K51.31

Non-billable

Ulcerative (chronic) rectosigmoiditis with complications

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

Code Description

ICD-10 K51.31 is a used to indicate a diagnosis of ulcerative (chronic) rectosigmoiditis with complications.

Key Diagnostic Point:

K51.31 refers to ulcerative (chronic) rectosigmoiditis with complications, a form of inflammatory bowel disease (IBD) that primarily affects the rectum and sigmoid colon. Clinically, patients may present with symptoms such as abdominal pain, diarrhea (often bloody), urgency, and tenesmus. The anatomy involved includes the rectum and the sigmoid colon, which are critical components of the lower gastrointestinal tract. Disease progression can lead to complications such as strictures, perforations, or toxic megacolon, necessitating careful monitoring and management. Diagnostic considerations include endoscopic evaluation, histological examination of biopsy samples, and imaging studies to assess the extent of inflammation and rule out other conditions. Chronic rectosigmoiditis can significantly impact a patient's quality of life and may require a multidisciplinary approach for management, including medication, dietary changes, and possibly surgical intervention in severe cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differentiation from other gastrointestinal disorders.
  • Treatment complexity: Management may involve multiple therapies, including immunosuppressants and biologics.
  • Documentation requirements: Detailed clinical notes and evidence of complications are essential for accurate coding.
  • Coding specificity: Requires precise coding to reflect the specific complications and severity of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity or type of ulcerative colitis.
  • Documentation gaps: Incomplete clinical notes regarding complications or treatment response.
  • Billing challenges: Potential denials due to insufficient documentation supporting 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

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

K51.31 has significant clinical implications, affecting a substantial portion of the population with inflammatory bowel disease. The condition can lead to increased healthcare utilization, including frequent hospitalizations and surgeries, impacting overall healthcare costs. Quality measures related to the management of ulcerative colitis focus on symptom control, patient education, and monitoring for complications, which are essential for improving patient outcomes and reducing the burden on healthcare systems.

ICD-9 vs ICD-10

K51.31 has significant clinical implications, affecting a substantial portion of the population with inflammatory bowel disease. The condition can lead to increased healthcare utilization, including frequent hospitalizations and surgeries, impacting overall healthcare costs. Quality measures related to the management of ulcerative colitis focus on symptom control, patient education, and monitoring for complications, which are essential for improving patient outcomes and reducing the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care provided, which may involve higher-level evaluation and management (E/M) services. Common denials can occur if documentation does not sufficiently support the presence of complications or if the coding does not align with the clinical findings. Best practices include ensuring that all relevant clinical information is captured in the medical record and that coding is performed accurately to reflect the severity 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 K51.31?

K51.31 covers chronic ulcerative rectosigmoiditis with complications such as strictures, perforations, or toxic megacolon. It is characterized by inflammation and ulceration of the rectum and sigmoid colon, leading to significant gastrointestinal symptoms.

When should K51.31 be used instead of related codes?

K51.31 should be used when there is documented evidence of complications associated with chronic rectosigmoiditis. If the condition is uncomplicated, K51.30 would be more appropriate. Accurate differentiation is crucial for proper treatment and reimbursement.

What documentation supports K51.31?

Documentation for K51.31 should include clinical notes detailing the patient's symptoms, diagnostic test results, evidence of complications, treatment plans, and responses to therapy. Endoscopic findings and biopsy results are particularly important.