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ICD-10 Guide
ICD-10 CodesK68.12

K68.12

Billable

Psoas muscle abscess

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

Code Description

ICD-10 K68.12 is a billable code used to indicate a diagnosis of psoas muscle abscess.

Key Diagnostic Point:

Psoas muscle abscess is a localized collection of pus within the psoas muscle, often resulting from infection or inflammation. Clinically, patients may present with flank pain, fever, and difficulty in hip flexion. The psoas muscle, located in the posterior abdominal wall, plays a crucial role in hip movement and stability. Abscess formation can occur due to various etiologies, including bacterial infections, particularly from conditions like appendicitis, diverticulitis, or hematogenous spread from distant infections. Disease progression may lead to severe complications if left untreated, including sepsis or chronic pain syndromes. Diagnostic considerations include imaging studies such as ultrasound or CT scans, which can reveal the presence of an abscess. Laboratory tests may show elevated white blood cell counts and inflammatory markers. Early diagnosis and intervention are critical to prevent complications and ensure favorable outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve surgical intervention or drainage.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary.
  • Coding specificity: Requires precise coding to differentiate from other abscess types.

Audit Risk Factors

  • Common coding errors: Misidentification of the abscess location.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging.
  • Billing challenges: Difficulty in justifying surgical procedures without adequate documentation.

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

Psoas muscle abscesses can significantly impact patient health, leading to increased morbidity if not promptly addressed. They are relatively rare but can indicate underlying systemic infections. Understanding the epidemiology of such abscesses helps in identifying at-risk populations and improving healthcare utilization patterns. Quality measures may include timely diagnosis and treatment to prevent complications.

ICD-9 vs ICD-10

Psoas muscle abscesses can significantly impact patient health, leading to increased morbidity if not promptly addressed. They are relatively rare but can indicate underlying systemic infections. Understanding the epidemiology of such abscesses helps in identifying at-risk populations and improving healthcare utilization patterns. Quality measures may include timely diagnosis and treatment to prevent complications.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case, the need for imaging studies, and potential surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include ensuring all clinical notes are thorough and that imaging results are clearly linked to the diagnosis.

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 K68.12?

K68.12 specifically covers psoas muscle abscesses, which may arise from infections such as pyelonephritis, appendicitis, or direct trauma. It is essential to differentiate it from other types of abscesses in the abdominal cavity.

When should K68.12 be used instead of related codes?

K68.12 should be used when the abscess is specifically located in the psoas muscle, as opposed to other abdominal abscess codes which may refer to different anatomical sites.

What documentation supports K68.12?

Documentation should include clinical findings, imaging results confirming the presence of a psoas abscess, laboratory results indicating infection, and any treatment plans or surgical notes.