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ICD-10 Guide
ICD-10 CodesK51.813

K51.813

Billable

Other ulcerative colitis with fistula

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

Code Description

ICD-10 K51.813 is a billable code used to indicate a diagnosis of other ulcerative colitis with fistula.

Key Diagnostic Point:

K51.813 refers to 'Other ulcerative colitis with fistula,' a subtype of ulcerative colitis characterized by inflammation and ulceration of the colonic mucosa, leading to the formation of abnormal connections (fistulas) between the colon and adjacent structures. Clinically, patients may present with symptoms such as abdominal pain, diarrhea (often bloody), weight loss, and fatigue. The presence of a fistula can complicate the clinical picture, potentially leading to additional symptoms such as fecal incontinence or recurrent infections. The anatomy involved primarily includes the colon, but fistulas may connect to the bladder, vagina, or skin, depending on their location. Disease progression can vary; some patients may experience intermittent flares, while others may have a more chronic course. Diagnostic considerations include colonoscopy, imaging studies (like CT or MRI), and laboratory tests to assess inflammation and rule out other conditions. Accurate diagnosis is crucial for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to differentiate from other gastrointestinal disorders.
  • Treatment complexity: Management may involve medications, surgery, or both, depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to capture the presence of fistulas and other complications.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcerative colitis types or failure to document fistula presence.
  • Documentation gaps: Incomplete clinical notes that do not fully describe the patient's condition.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity or lack of detailed 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

Colorectal 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

The clinical significance of K51.813 lies in its association with severe gastrointestinal complications, which can lead to increased healthcare utilization and costs. The presence of fistulas often necessitates more intensive treatment and monitoring, impacting population health outcomes. Quality measures may focus on the management of ulcerative colitis and its complications, highlighting the importance of effective care strategies to improve patient quality of life and reduce hospitalizations.

ICD-9 vs ICD-10

The clinical significance of K51.813 lies in its association with severe gastrointestinal complications, which can lead to increased healthcare utilization and costs. The presence of fistulas often necessitates more intensive treatment and monitoring, impacting population health outcomes. Quality measures may focus on the management of ulcerative colitis and its complications, highlighting the importance of effective care strategies to improve patient quality of life and reduce hospitalizations.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for procedures and treatments is clearly documented. Common denials may arise from insufficient evidence of the fistula's impact on the patient's health or failure to provide adequate clinical notes. Best practices include maintaining thorough documentation of all clinical encounters, treatment plans, and patient responses to therapy, as well as ensuring that coding accurately reflects the complexity of the patient's condition.

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 K51.813?

K51.813 covers ulcerative colitis with the presence of fistulas, which may involve connections to other organs or tissues. This includes fistulas that may lead to complications such as abscess formation or recurrent infections.

When should K51.813 be used instead of related codes?

K51.813 should be used when the patient has a confirmed diagnosis of ulcerative colitis accompanied by a fistula. It is important to differentiate from codes that do not specify fistula presence, as this impacts treatment and management strategies.

What documentation supports K51.813?

Documentation should include a comprehensive clinical evaluation, imaging studies confirming the fistula, treatment plans, and any relevant laboratory results. Detailed notes on the patient's symptoms and response to treatment are also essential.