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ICD-10 Guide
ICD-10 CodesK60.511

K60.511

Billable

Anorectal fistula, simple, initial

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

Code Description

ICD-10 K60.511 is a billable code used to indicate a diagnosis of anorectal fistula, simple, initial.

Key Diagnostic Point:

Anorectal fistula, simple, initial (K60.511) refers to a pathological connection between the anal canal and the perianal skin, typically resulting from an infection that leads to the formation of an abscess. Clinically, patients may present with symptoms such as pain, swelling, and discharge near the anus. The anatomy involved includes the anal canal, rectum, and surrounding soft tissue. Disease progression can vary; if left untreated, a simple anorectal fistula may become more complex, potentially leading to recurrent infections or complications. Diagnosis often involves a thorough clinical examination, possibly supplemented by imaging studies such as MRI or ultrasound to assess the fistula's tract and any associated abscesses. The initial presentation is crucial for determining the appropriate treatment plan, which may include surgical intervention to excise the fistula and promote healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly imaging for accurate diagnosis.
  • Treatment complexity: Surgical intervention may be necessary, with varying techniques based on fistula complexity.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate between simple and complex fistulas.

Audit Risk Factors

  • Common coding errors: Misclassification of simple vs. complex fistulas.
  • Documentation gaps: Incomplete clinical notes regarding the fistula's characteristics.
  • Billing challenges: Potential denials if documentation does not support the complexity of the condition.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K60.511 lies in its potential to cause discomfort and complications if untreated. Anorectal fistulas can impact population health by leading to increased healthcare utilization due to recurrent infections and the need for surgical interventions. Quality measures may include tracking the rates of successful fistula repairs and patient satisfaction post-treatment. Understanding the epidemiology of anorectal conditions can help healthcare providers address risk factors and improve patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K60.511 lies in its potential to cause discomfort and complications if untreated. Anorectal fistulas can impact population health by leading to increased healthcare utilization due to recurrent infections and the need for surgical interventions. Quality measures may include tracking the rates of successful fistula repairs and patient satisfaction post-treatment. Understanding the epidemiology of anorectal conditions can help healthcare providers address risk factors and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure and the setting in which it is performed. Common denials may arise from insufficient documentation or incorrect coding of the fistula type. Best practices include ensuring that all clinical notes are complete and that the 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 K60.511?

K60.511 specifically covers simple anorectal fistulas that are not associated with complex features such as multiple tracts or significant tissue loss. It is typically diagnosed following an abscess formation and is characterized by a straightforward connection between the anal canal and the skin.

When should K60.511 be used instead of related codes?

K60.511 should be used when the fistula is classified as simple, without any complicating factors. If the fistula has multiple tracts, significant tissue loss, or other complexities, codes such as K60.512 should be considered.

What documentation supports K60.511?

Documentation should include a detailed clinical examination, description of symptoms, imaging studies if performed, and the treatment plan. Notes should clearly indicate the diagnosis of a simple anorectal fistula and any relevant surgical interventions.