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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK60

K60

Non-billable

Fissure and fistula of anal and rectal regions

Chapter 11:Diseases of the digestive system

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 K60 is a used to indicate a diagnosis of fissure and fistula of anal and rectal regions.

Key Diagnostic Point:

The ICD-10 Level 1 Category code K60 encompasses conditions related to fissures and fistulas of the anal and rectal regions. Anal fissures are small tears in the lining of the anus, often resulting from trauma during bowel movements, while anal fistulas are abnormal connections between the anal canal and the skin surrounding the anus, typically arising from an infection or abscess. These conditions can lead to significant discomfort, pain, and complications if left untreated, making accurate diagnosis and coding essential for effective management and treatment. Clinicians should be aware of the symptoms, which may include pain during defecation, bleeding, and swelling, to ensure appropriate intervention and care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation
  • Potential for complications
  • Need for surgical intervention in some cases

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Misclassification of severity
  • Failure to capture associated conditions

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

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 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 and administrative impact of the K60 code category is significant, as it directly relates to the management of common yet impactful conditions affecting patient quality of life. Accurate coding can influence quality measures, such as patient satisfaction and treatment outcomes, which are increasingly important in value-based care models. Furthermore, understanding population health implications, such as the prevalence of anal fissures and fistulas, can guide healthcare providers in resource allocation and preventive care strategies. As healthcare trends evolve, addressing these conditions effectively can contribute to improved patient outcomes and reduced healthcare costs.

ICD-9 vs ICD-10

The clinical and administrative impact of the K60 code category is significant, as it directly relates to the management of common yet impactful conditions affecting patient quality of life. Accurate coding can influence quality measures, such as patient satisfaction and treatment outcomes, which are increasingly important in value-based care models. Furthermore, understanding population health implications, such as the prevalence of anal fissures and fistulas, can guide healthcare providers in resource allocation and preventive care strategies. As healthcare trends evolve, addressing these conditions effectively can contribute to improved patient outcomes and reduced healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the condition, the treatment provided, and the payer's policies. It is crucial to stay updated on coding changes and payer guidelines to optimize reimbursement and minimize claim denials. Additionally, understanding the common billing practices for related CPT codes will aid in streamlining the billing process.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for K60

Coding & Billing References

  • •
    Official ICD-10 Guidelines for K60

Frequently Asked Questions

What conditions are included in K60?

K60 includes anal fissures, anal fistulas, and other specified conditions affecting the anal and rectal regions, such as perianal abscesses.

When should I use K60 codes?

K60 codes should be used when diagnosing and treating patients with anal fissures or fistulas, particularly when there is documentation of symptoms and clinical findings that support the diagnosis.

What documentation is required for K60?

Documentation should include patient history, clinical findings, treatment plans, and any surgical interventions performed. Detailed notes on symptoms and their impact on the patient's quality of life are also essential.