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ICD-10 Guide
ICD-10 CodesK51.019

K51.019

Billable

Ulcerative (chronic) pancolitis with unspecified complications

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

Code Description

ICD-10 K51.019 is a billable code used to indicate a diagnosis of ulcerative (chronic) pancolitis with unspecified complications.

Key Diagnostic Point:

Ulcerative pancolitis is a chronic inflammatory bowel disease characterized by inflammation and ulceration of the colonic mucosa, affecting the entire colon (pancolitis). Clinically, patients may present with symptoms such as abdominal pain, diarrhea (often bloody), urgency, and weight loss. The anatomy involved includes the entire colon, which can lead to complications such as toxic megacolon, perforation, and increased risk of colorectal cancer over time. Disease progression can vary, with periods of exacerbation and remission. Diagnostic considerations include a thorough patient history, physical examination, stool studies, endoscopy with biopsy, and imaging studies to rule out other conditions. The unspecified complications in K51.019 indicate that while the patient has chronic ulcerative pancolitis, specific complications have not been documented or identified, necessitating careful monitoring and management to prevent potential severe outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation and differentiation from other gastrointestinal disorders.
  • Treatment complexity: Management may involve medications, lifestyle changes, and possibly surgery.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis and any associated complications.
  • Coding specificity: While K51.019 is specific, it lacks detail on complications, which can complicate coding.

Audit Risk Factors

  • Common coding errors: Misclassification with other forms of ulcerative colitis or inflammatory bowel disease.
  • Documentation gaps: Incomplete records regarding the extent of the disease or complications.
  • Billing challenges: Potential denials due to lack of specificity in documentation or failure to meet medical necessity criteria.

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

Internal Medicine

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

Ulcerative pancolitis significantly impacts patient quality of life and healthcare utilization, often leading to frequent medical visits, hospitalizations, and potential surgeries. The condition is prevalent in various populations, necessitating effective management strategies to reduce complications and improve health outcomes. Quality measures may include monitoring disease activity, adherence to treatment protocols, and screening for colorectal cancer in at-risk patients.

ICD-9 vs ICD-10

Ulcerative pancolitis significantly impacts patient quality of life and healthcare utilization, often leading to frequent medical visits, hospitalizations, and potential surgeries. The condition is prevalent in various populations, necessitating effective management strategies to reduce complications and improve health outcomes. Quality measures may include monitoring disease activity, adherence to treatment protocols, and screening for colorectal cancer in at-risk patients.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical evidence and that the services rendered are medically necessary. Common denials may arise from insufficient documentation or failure to specify the nature of the complications. Best practices include maintaining thorough records of patient visits, treatment plans, and any diagnostic tests performed to substantiate the claim.

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 K51.019?

K51.019 covers chronic ulcerative pancolitis without specified complications. It includes patients experiencing symptoms of pancolitis but does not detail any specific complications such as toxic megacolon or colorectal cancer.

When should K51.019 be used instead of related codes?

K51.019 should be used when a patient has chronic ulcerative pancolitis affecting the entire colon without documented complications. If complications are present, more specific codes should be utilized.

What documentation supports K51.019?

Documentation should include a confirmed diagnosis of ulcerative pancolitis through endoscopic findings, biopsy results, and a comprehensive assessment of the patient's symptoms and medical history.