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ICD-10 Guide
ICD-10 CodesK51.91

K51.91

Non-billable

Ulcerative colitis, unspecified, with complications

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

Code Description

ICD-10 K51.91 is a used to indicate a diagnosis of ulcerative colitis, unspecified, with complications.

Key Diagnostic Point:

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by inflammation and ulceration of the colonic mucosa. The condition typically presents with symptoms such as abdominal pain, diarrhea, rectal bleeding, and urgency. The anatomy involved primarily includes the colon and rectum, with varying degrees of involvement from the rectum alone (proctitis) to the entire colon (pancolitis). Disease progression can lead to complications such as severe dehydration, toxic megacolon, perforation, and increased risk of colorectal cancer. Diagnostic considerations for K51.91 include a thorough patient history, physical examination, and diagnostic tests such as colonoscopy with biopsy, imaging studies, and laboratory tests to rule out other gastrointestinal conditions. The unspecified nature of this code indicates that while complications are present, the specific type or severity of ulcerative colitis has not been detailed, necessitating careful clinical evaluation and documentation to guide treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation to differentiate from other gastrointestinal disorders.
  • Treatment complexity: Management may involve medications, dietary changes, and possibly surgery.
  • Documentation requirements: Detailed clinical notes are essential to justify the diagnosis and treatment.
  • Coding specificity: The unspecified nature of K51.91 may lead to challenges in accurately capturing the patient's condition.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcerative colitis severity or complications.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the patient's condition.
  • Billing challenges: Potential for denials if documentation does not support the complexity of 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

Internal Medicine

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 colitis significantly impacts population health, affecting quality of life and leading to increased healthcare utilization. The condition is prevalent in various demographics, with potential long-term complications such as colorectal cancer. Quality measures focus on effective management and monitoring of patients to reduce hospitalizations and improve outcomes. Understanding the epidemiology of ulcerative colitis can help healthcare providers implement preventive strategies and enhance patient care.

ICD-9 vs ICD-10

Ulcerative colitis significantly impacts population health, affecting quality of life and leading to increased healthcare utilization. The condition is prevalent in various demographics, with potential long-term complications such as colorectal cancer. Quality measures focus on effective management and monitoring of patients to reduce hospitalizations and improve outcomes. Understanding the epidemiology of ulcerative colitis can help healthcare providers implement preventive strategies and enhance patient care.

Reimbursement & Billing Impact

Reimbursement may be affected by the specificity of the diagnosis, so accurate coding is essential to avoid denials. Common challenges include ensuring that all complications are documented and that the medical necessity for treatments is clearly established. Adhering to coding best practices and maintaining thorough documentation can mitigate billing issues.

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 K51.91?

K51.91 covers ulcerative colitis with unspecified complications, which may include severe symptoms, hospitalization, or other complications like toxic megacolon or perforation, but does not specify the exact nature of these complications.

When should K51.91 be used instead of related codes?

K51.91 should be used when a patient presents with ulcerative colitis and complications, but the specific type or severity of the complications is not clearly defined. If the complications are specified, more specific codes should be utilized.

What documentation supports K51.91?

Documentation should include a detailed patient history, clinical findings, results from diagnostic tests (e.g., colonoscopy), and any treatment plans that indicate the presence of complications associated with ulcerative colitis.