ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK61.3

K61.3

Non-billable

Ischiorectal abscess

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

Code Description

ICD-10 K61.3 is a used to indicate a diagnosis of ischiorectal abscess.

Key Diagnostic Point:

Ischiorectal abscess is a localized collection of pus that occurs in the ischiorectal fossa, an anatomical space located between the ischium and the rectum. This condition typically arises from an infection of the anal glands, which can lead to the formation of an abscess. Patients often present with symptoms such as severe perianal pain, swelling, fever, and difficulty in sitting or defecating. The abscess may be palpable on examination and can cause systemic symptoms if not treated promptly. The disease progression can lead to complications such as fistula formation if the abscess is not drained adequately. Diagnosis is primarily clinical, supported by imaging studies such as ultrasound or MRI in complicated cases. Treatment involves surgical intervention for drainage, along with antibiotics to manage the infection. Proper identification and management are crucial to prevent recurrence and further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly imaging for accurate diagnosis.
  • Treatment complexity: Involves surgical intervention and post-operative care.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires precise coding to differentiate from other abscess types.

Audit Risk Factors

  • Common coding errors: Misclassification with other abscess codes.
  • Documentation gaps: Incomplete records of symptoms and treatment.
  • Billing challenges: Denials due to lack of supporting documentation for surgical procedures.

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: General 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

Ischiorectal abscesses, while relatively uncommon, can significantly impact patient quality of life and healthcare utilization. Early diagnosis and treatment are essential to prevent complications such as fistula formation, which can lead to increased healthcare costs and prolonged recovery times. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient outcomes.

ICD-9 vs ICD-10

Ischiorectal abscesses, while relatively uncommon, can significantly impact patient quality of life and healthcare utilization. Early diagnosis and treatment are essential to prevent complications such as fistula formation, which can lead to increased healthcare costs and prolonged recovery times. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure and any associated post-operative care. Common denials may arise from insufficient documentation or misclassification of the abscess type. Coders should ensure that all relevant clinical notes are included to support the medical necessity of the procedure and to avoid billing challenges.

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 K61.3?

K61.3 specifically covers ischiorectal abscesses, which are infections localized to the ischiorectal fossa. It does not include abscesses in other locations such as perianal or rectal abscesses, which are classified under different codes.

When should K61.3 be used instead of related codes?

K61.3 should be used when the abscess is specifically located in the ischiorectal fossa, as opposed to K61.0 for perianal abscesses or K61.1 for rectal abscesses. Accurate anatomical localization is key for correct coding.

What documentation supports K61.3?

Documentation should include clinical findings such as pain location, fever, and any imaging studies performed. Surgical notes detailing the drainage procedure and post-operative care are also essential for supporting the use of K61.3.