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ICD-10 Guide
ICD-10 CodesK51.20

K51.20

Billable

Ulcerative (chronic) proctitis without complications

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

Code Description

ICD-10 K51.20 is a billable code used to indicate a diagnosis of ulcerative (chronic) proctitis without complications.

Key Diagnostic Point:

K51.20 refers to ulcerative proctitis, a form of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulceration of the rectal mucosa. Clinically, patients may present with symptoms such as rectal bleeding, diarrhea, abdominal pain, and tenesmus. The anatomy involved primarily includes the rectum, which is the terminal part of the large intestine. Disease progression can vary; some patients may experience intermittent flares of symptoms, while others may have a more chronic course. Diagnostic considerations include a thorough patient history, physical examination, and confirmatory tests such as colonoscopy with biopsy to assess the extent of inflammation and rule out other conditions. The absence of complications, such as strictures or perforations, is a key factor in classifying the condition under K51.20. Regular monitoring and follow-up are essential to manage symptoms and prevent potential complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific tests like colonoscopy for accurate diagnosis.
  • Treatment complexity: Management may involve medications such as 5-ASA compounds or corticosteroids.
  • Documentation requirements: Detailed clinical notes and symptom tracking are necessary for accurate coding.
  • Coding specificity: Differentiating between ulcerative proctitis and other forms of IBD requires precise coding.

Audit Risk Factors

  • Common coding errors: Misclassification with other forms of IBD or gastrointestinal disorders.
  • Documentation gaps: Incomplete clinical notes regarding symptom severity and treatment response.
  • Billing challenges: Potential denials due to lack of supporting documentation for chronicity or severity.

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

Primary Care

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 proctitis significantly impacts patient quality of life and healthcare utilization. It is essential to monitor the condition to prevent complications and manage symptoms effectively. The prevalence of ulcerative proctitis contributes to the overall burden of inflammatory bowel diseases in the population, highlighting the need for targeted healthcare resources and quality measures to improve patient outcomes.

ICD-9 vs ICD-10

Ulcerative proctitis significantly impacts patient quality of life and healthcare utilization. It is essential to monitor the condition to prevent complications and manage symptoms effectively. The prevalence of ulcerative proctitis contributes to the overall burden of inflammatory bowel diseases in the population, highlighting the need for targeted healthcare resources and quality measures to improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of chronicity and the absence of complications. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include maintaining thorough clinical notes, ensuring accurate coding, and verifying that all necessary tests and treatments are documented to support 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 K51.20?

K51.20 specifically covers ulcerative proctitis without complications. This includes chronic inflammation and ulceration localized to the rectum, without any associated complications such as abscesses or strictures.

When should K51.20 be used instead of related codes?

K51.20 should be used when the patient has a confirmed diagnosis of ulcerative proctitis without complications. It is important to differentiate it from K51.21 (with complications) and other forms of IBD, such as Crohn's disease.

What documentation supports K51.20?

Documentation should include a detailed patient history, physical examination findings, results from colonoscopy and biopsy, and treatment plans. Evidence of chronicity and absence of complications must be clearly noted.