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ICD-10 Guide
ICD-10 CodesK51.318

K51.318

Billable

Ulcerative (chronic) rectosigmoiditis with other complication

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

Code Description

ICD-10 K51.318 is a billable code used to indicate a diagnosis of ulcerative (chronic) rectosigmoiditis with other complication.

Key Diagnostic Point:

K51.318 refers to ulcerative (chronic) rectosigmoiditis with other complications, a subtype of ulcerative colitis affecting the rectum and sigmoid colon. Clinically, patients may present with symptoms such as abdominal pain, rectal bleeding, diarrhea, and urgency. The anatomy involved includes the rectum and sigmoid colon, which are critical components of the lower gastrointestinal tract. Disease progression can vary, with some patients experiencing intermittent flare-ups and others facing chronic symptoms that may lead to complications such as strictures, perforation, or increased risk of colorectal cancer. Diagnostic considerations include a thorough patient history, physical examination, and confirmatory tests such as colonoscopy with biopsy, which can help differentiate ulcerative rectosigmoiditis from other gastrointestinal disorders. The presence of other complications may necessitate additional diagnostic imaging or laboratory tests to assess the extent of the disease and guide treatment options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation to differentiate from other gastrointestinal diseases.
  • Treatment complexity: Management may involve medications, dietary changes, and possibly surgical interventions.
  • Documentation requirements: Detailed clinical documentation is essential for accurate coding and reimbursement.
  • Coding specificity: Requires precise coding to capture the specific complications associated with the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of the condition or failure to document complications.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the patient's condition.
  • Billing challenges: Potential for claim denials if documentation does not support the complexity of 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

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 rectosigmoiditis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and outpatient visits. The condition is prevalent in various populations, with epidemiological studies indicating a rising incidence. Quality measures related to the management of ulcerative colitis, including K51.318, focus on improving patient outcomes and reducing complications, thereby enhancing overall population health.

ICD-9 vs ICD-10

Ulcerative rectosigmoiditis significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and outpatient visits. The condition is prevalent in various populations, with epidemiological studies indicating a rising incidence. Quality measures related to the management of ulcerative colitis, including K51.318, focus on improving patient outcomes and reducing complications, thereby enhancing overall population health.

Reimbursement & Billing Impact

Reimbursement considerations include the potential for higher payments due to the complexity of the condition. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the diagnosis. It is crucial to ensure that all relevant clinical information is included in the patient's medical record to avoid billing challenges and ensure compliance with payer requirements.

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 K51.318?

K51.318 covers chronic ulcerative rectosigmoiditis with complications such as strictures, abscesses, or fistulas. It is important to document the specific complications present to justify the use of this code.

When should K51.318 be used instead of related codes?

K51.318 should be used when the patient has chronic ulcerative rectosigmoiditis accompanied by other complications. If there are no complications, K51.319 should be used instead.

What documentation supports K51.318?

Documentation should include a detailed clinical history, physical examination findings, results from diagnostic tests (e.g., colonoscopy), and notes on any complications observed during treatment.