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v1.0.0
ICD-10 Guide
ICD-10 CodesK61.4

K61.4

Billable

Intrasphincteric abscess

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

Code Description

ICD-10 K61.4 is a billable code used to indicate a diagnosis of intrasphincteric abscess.

Key Diagnostic Point:

Intrasphincteric abscess is a localized collection of pus that occurs within the intrasphincteric space, which is situated between the internal and external anal sphincters. This condition typically arises from the infection of anal glands, leading to the formation of an abscess. Clinically, patients may present with symptoms such as anal pain, swelling, fever, and sometimes drainage of pus. The anatomy involved includes the anal canal, the sphincter muscles, and surrounding soft tissues. Disease progression can lead to complications such as fistula formation if not treated promptly. Diagnosis is primarily clinical, supported by physical examination and imaging studies like ultrasound or MRI when necessary. Differential diagnoses include perianal abscess and other forms of anal abscesses, which must be carefully distinguished to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and sometimes imaging for accurate diagnosis.
  • Treatment complexity: May involve surgical intervention for drainage and management of underlying causes.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of abscesses.

Audit Risk Factors

  • Common coding errors: Misclassification with other abscess codes.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • Billing challenges: Potential denials if documentation does not clearly support 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

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

Intrasphincteric abscesses, while not extremely common, can significantly impact patient quality of life and healthcare utilization. They may lead to complications such as fistulas, which require further surgical intervention. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient outcomes, particularly in populations at higher risk for anal abscesses.

ICD-9 vs ICD-10

Intrasphincteric abscesses, while not extremely common, can significantly impact patient quality of life and healthcare utilization. They may lead to complications such as fistulas, which require further surgical intervention. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient outcomes, particularly in populations at higher risk for anal abscesses.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure and the setting in which care is provided. Common denials may arise from insufficient documentation or misclassification of the abscess type. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the diagnosis and treatment provided.

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 K61.4?

K61.4 specifically covers intrasphincteric abscesses, which are characterized by pus accumulation in the intrasphincteric space. It does not include other types of anal abscesses, such as perianal or ischiorectal abscesses.

When should K61.4 be used instead of related codes?

K61.4 should be used when the abscess is specifically located in the intrasphincteric space. If the abscess is located elsewhere, such as in the perianal or ischiorectal regions, the appropriate codes K61.0 or K61.1 should be utilized.

What documentation supports K61.4?

Documentation should include a thorough clinical assessment, imaging results if applicable, treatment plans, and any surgical notes if drainage was performed. Clear descriptions of symptoms and the location of the abscess are crucial.