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ICD-10 Guide
ICD-10 CodesK51.419

K51.419

Billable

Inflammatory polyps of colon with unspecified complications

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

Code Description

ICD-10 K51.419 is a billable code used to indicate a diagnosis of inflammatory polyps of colon with unspecified complications.

Key Diagnostic Point:

K51.419 refers to inflammatory polyps of the colon with unspecified complications. Inflammatory polyps are benign lesions that arise in the colon, often associated with conditions such as ulcerative colitis. Clinically, patients may present with symptoms including abdominal pain, diarrhea, rectal bleeding, and changes in bowel habits. The anatomy involved primarily includes the colon, where these polyps can develop due to chronic inflammation. Disease progression may vary; while some patients may remain asymptomatic, others may experience complications such as obstruction or increased risk of colorectal cancer, particularly in the context of underlying inflammatory bowel disease. Diagnostic considerations include colonoscopy for direct visualization and biopsy of the polyps, along with imaging studies to assess for complications. Accurate diagnosis is crucial for appropriate management and surveillance strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of inflammatory bowel disease and its manifestations.
  • Treatment complexity: Management may involve medical therapy, surveillance, and potential surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and any associated complications.
  • Coding specificity: Requires precise coding to differentiate from other types of polyps or colonic conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of polyps or failure to document complications.
  • Documentation gaps: Incomplete clinical notes that do not specify the nature of complications.
  • Billing challenges: Potential denials if the documentation does not clearly support the diagnosis or if coding is not aligned with clinical findings.

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

Pathology

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 K51.419 lies in its association with inflammatory bowel disease, which affects a substantial population and can lead to serious complications if not managed properly. Understanding the epidemiology of inflammatory polyps can inform healthcare utilization patterns, as patients may require ongoing surveillance and treatment. Quality measures related to colorectal cancer screening and management of inflammatory bowel disease are also impacted by accurate coding and documentation.

ICD-9 vs ICD-10

The clinical significance of K51.419 lies in its association with inflammatory bowel disease, which affects a substantial population and can lead to serious complications if not managed properly. Understanding the epidemiology of inflammatory polyps can inform healthcare utilization patterns, as patients may require ongoing surveillance and treatment. Quality measures related to colorectal cancer screening and management of inflammatory bowel disease are also impacted by accurate coding and documentation.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity for follow-up care. 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 aligns with the services provided to 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 K51.419?

K51.419 specifically covers inflammatory polyps of the colon that are associated with inflammatory bowel disease, particularly ulcerative colitis, and may include complications that are not explicitly defined.

When should K51.419 be used instead of related codes?

K51.419 should be used when there is documentation of inflammatory polyps with unspecified complications, distinguishing it from codes that specify no complications or other types of polyps.

What documentation supports K51.419?

Documentation should include clinical findings from colonoscopy, biopsy results, and any relevant history of inflammatory bowel disease, as well as notes on symptoms and complications.