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ICD-10 Guide
ICD-10 CodesK51.219

K51.219

Billable

Ulcerative (chronic) proctitis with unspecified complications

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

Code Description

ICD-10 K51.219 is a billable code used to indicate a diagnosis of ulcerative (chronic) proctitis with unspecified complications.

Key Diagnostic Point:

K51.219 refers to ulcerative proctitis, a form of inflammatory bowel disease (IBD) characterized by inflammation and ulceration of the rectal mucosa. Clinically, patients may present with symptoms such as rectal bleeding, diarrhea, abdominal pain, and urgency to defecate. The anatomy involved primarily includes the rectum, which may exhibit varying degrees of inflammation and ulceration. Disease progression can lead to complications such as strictures, abscesses, or even colorectal cancer if left untreated. 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 chronic nature of this condition necessitates ongoing management and monitoring to prevent exacerbations and complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis to rule out other gastrointestinal disorders.
  • Treatment complexity: Management may involve medications such as aminosalicylates, corticosteroids, or immunosuppressants.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of IBD.

Audit Risk Factors

  • Common coding errors: Misclassification with other types of IBD or gastrointestinal disorders.
  • Documentation gaps: Insufficient clinical details to support the diagnosis.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

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

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 associated with increased healthcare costs due to frequent medical visits, diagnostic procedures, and potential hospitalizations. Understanding the epidemiology of this condition helps in developing targeted interventions and quality measures aimed at improving patient outcomes and managing population health effectively.

ICD-9 vs ICD-10

Ulcerative proctitis significantly impacts patient quality of life and healthcare utilization. It is associated with increased healthcare costs due to frequent medical visits, diagnostic procedures, and potential hospitalizations. Understanding the epidemiology of this condition helps in developing targeted interventions and quality measures aimed at improving patient outcomes and managing population health effectively.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of the condition's chronicity and any complications. Common denials may arise from insufficient documentation or failure to provide supporting clinical evidence. Best practices include maintaining thorough records of patient encounters, treatment plans, and follow-up care to ensure compliance with payer requirements and minimize audit risks.

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 K51.219?

K51.219 specifically covers ulcerative proctitis without specified complications. It includes cases where the extent of the disease is not fully characterized, but symptoms and clinical findings indicate proctitis.

When should K51.219 be used instead of related codes?

K51.219 should be used when the diagnosis is confirmed as ulcerative proctitis without specified complications, distinguishing it from other forms of ulcerative colitis or gastrointestinal disorders.

What documentation supports K51.219?

Documentation should include a detailed patient history, clinical findings, results from diagnostic tests such as colonoscopy, and any treatment plans or responses to therapy.