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ICD-10 Guide
ICD-10 CodesK51.414

K51.414

Billable

Inflammatory polyps of colon with abscess

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

Code Description

ICD-10 K51.414 is a billable code used to indicate a diagnosis of inflammatory polyps of colon with abscess.

Key Diagnostic Point:

K51.414 refers to inflammatory polyps of the colon with abscess formation, a condition that typically arises from chronic inflammatory bowel diseases such as ulcerative colitis. Clinically, patients may present with symptoms including abdominal pain, rectal bleeding, diarrhea, and tenesmus. The anatomy involved primarily includes the colon, where inflammatory polyps can develop due to the ongoing inflammatory process. Disease progression may lead to complications such as abscess formation, which can cause localized pain, fever, and systemic symptoms. Diagnostic considerations include colonoscopy, which allows for direct visualization of the polyps and potential biopsy for histological examination. Imaging studies such as CT scans may also be utilized to assess for abscesses and other complications. Early diagnosis and management are crucial to prevent further complications, including perforation or sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to differentiate from other colonic conditions.
  • Treatment complexity: May involve medical management of underlying inflammatory bowel disease and surgical intervention for abscess.
  • 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 the type of polyp or absence of abscess.
  • Documentation gaps: Incomplete records regarding the extent of inflammation or abscess characteristics.
  • Billing challenges: Potential denials due to insufficient documentation supporting the diagnosis and treatment.

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

General 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

The clinical significance of K51.414 lies in its association with inflammatory bowel diseases, which can lead to significant morbidity if not managed appropriately. Population health impact includes increased healthcare utilization due to complications such as abscesses, which may require hospitalization. Quality measures focus on timely diagnosis and effective management to reduce the risk of severe outcomes, highlighting the importance of accurate coding and documentation in improving patient care and outcomes.

ICD-9 vs ICD-10

The clinical significance of K51.414 lies in its association with inflammatory bowel diseases, which can lead to significant morbidity if not managed appropriately. Population health impact includes increased healthcare utilization due to complications such as abscesses, which may require hospitalization. Quality measures focus on timely diagnosis and effective management to reduce the risk of severe outcomes, highlighting the importance of accurate coding and documentation in improving patient care and outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of treatment, especially if surgical intervention is necessary for abscess drainage. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include ensuring that all clinical findings are well-documented and that coding accurately reflects the patient's condition 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 K51.414?

K51.414 specifically covers inflammatory polyps of the colon that are associated with abscess formation, typically seen in patients with underlying inflammatory bowel diseases such as ulcerative colitis. It does not include polyps that are benign or neoplastic in nature without inflammation.

When should K51.414 be used instead of related codes?

K51.414 should be used when there is clear documentation of inflammatory polyps accompanied by an abscess. If the polyps are present without abscess or if the condition is due to other causes, related codes such as K51.413 should be considered.

What documentation supports K51.414?

Documentation should include clinical notes detailing the patient's symptoms, results from colonoscopy or imaging studies, histopathological findings, and any treatment interventions undertaken. Clear evidence of abscess formation and its management is crucial.