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ICD-10 Guide
ICD-10 CodesK51.913

K51.913

Billable

Ulcerative colitis, unspecified with fistula

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

Code Description

ICD-10 K51.913 is a billable code used to indicate a diagnosis of ulcerative colitis, unspecified with fistula.

Key Diagnostic Point:

K51.913 refers to ulcerative colitis, unspecified, with fistula, a chronic inflammatory bowel disease primarily affecting the colon and rectum. This condition is characterized by inflammation and ulceration of the colonic mucosa, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding. The presence of a fistula indicates an abnormal connection between the colon and another organ or the skin, which can complicate the clinical picture. Disease progression can vary, with periods of exacerbation and remission. Diagnostic considerations include colonoscopy, imaging studies, and laboratory tests to assess inflammation and rule out other gastrointestinal disorders. The diagnosis of ulcerative colitis is often made based on clinical presentation, endoscopic findings, and histological examination of biopsy samples. Accurate diagnosis is crucial as it guides treatment options, which may include medications, dietary changes, and potentially surgical interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differentiation from other gastrointestinal conditions.
  • Treatment complexity: Involves a multidisciplinary approach including gastroenterologists, dietitians, and possibly surgeons.
  • Documentation requirements: Detailed clinical notes and diagnostic imaging results are necessary for accurate coding.
  • Coding specificity: Requires precise documentation of the condition and associated complications.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of ulcerative colitis or failure to document fistula presence.
  • Documentation gaps: Incomplete clinical notes that do not specify the nature of the fistula or disease severity.
  • Billing challenges: Potential denials due to lack of supporting documentation for the diagnosis and associated complications.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Ulcerative colitis significantly impacts population health, with increasing prevalence noted in various demographics. The presence of complications such as fistulas can lead to higher healthcare utilization, including increased hospitalizations and surgical interventions. Quality measures focus on managing symptoms effectively and improving patient outcomes, emphasizing the importance of early diagnosis and comprehensive treatment strategies.

ICD-9 vs ICD-10

Ulcerative colitis significantly impacts population health, with increasing prevalence noted in various demographics. The presence of complications such as fistulas can lead to higher healthcare utilization, including increased hospitalizations and surgical interventions. Quality measures focus on managing symptoms effectively and improving patient outcomes, emphasizing the importance of early diagnosis and comprehensive treatment strategies.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to ulcerative colitis and fistula management. Coders should ensure that all relevant clinical information is included in the patient's record to support the diagnosis and any claims submitted.

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 K51.913?

K51.913 covers ulcerative colitis that is unspecified in terms of severity or extent but includes the presence of a fistula. This may involve various types of fistulas, such as enteric or perianal, which can complicate the clinical management of the disease.

When should K51.913 be used instead of related codes?

K51.913 should be used when the patient has ulcerative colitis with a fistula, and the specifics of the ulcerative colitis are not detailed. If the type or extent of ulcerative colitis is known, a more specific code should be selected.

What documentation supports K51.913?

Documentation should include a comprehensive clinical assessment, endoscopic findings, biopsy results, and detailed notes on the presence and type of fistula. Clear descriptions of symptoms and treatment plans are also essential.