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ICD-10 Guide
ICD-10 CodesK52.3

K52.3

Billable

Indeterminate colitis

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

Code Description

ICD-10 K52.3 is a billable code used to indicate a diagnosis of indeterminate colitis.

Key Diagnostic Point:

Indeterminate colitis is a form of inflammatory bowel disease (IBD) characterized by inflammation of the colon that does not fit the specific criteria for either Crohn's disease or ulcerative colitis. Clinically, patients may present with symptoms such as abdominal pain, diarrhea (which may be bloody), weight loss, and fatigue. The anatomy involved primarily includes the colon, but the inflammation can also affect surrounding tissues. Disease progression can vary significantly among individuals; some may experience intermittent flares while others may have a more chronic course. Diagnostic considerations include a thorough patient history, physical examination, laboratory tests, and imaging studies, as well as endoscopic evaluation with biopsy to rule out other conditions. The indeterminate nature of this colitis type often complicates diagnosis, as it requires exclusion of other specific IBD types and may necessitate ongoing monitoring and reassessment over time.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other IBD types.
  • Treatment complexity: Management may involve various therapies including immunosuppressants and biologics.
  • Documentation requirements: Detailed clinical documentation is essential for accurate coding.
  • Coding specificity: Limited specificity compared to more defined IBD codes.

Audit Risk Factors

  • Common coding errors: Misclassification with other IBD codes.
  • Documentation gaps: Incomplete clinical notes may lead to coding inaccuracies.
  • Billing challenges: Potential for denials if documentation does not support 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

Indeterminate colitis can significantly impact patient quality of life and healthcare utilization patterns, as it often requires ongoing management and monitoring. The condition is part of the broader category of inflammatory bowel diseases, which have been increasing in prevalence globally. Understanding the epidemiological trends and quality measures associated with IBD can help healthcare providers improve patient outcomes and allocate resources effectively.

ICD-9 vs ICD-10

Indeterminate colitis can significantly impact patient quality of life and healthcare utilization patterns, as it often requires ongoing management and monitoring. The condition is part of the broader category of inflammatory bowel diseases, which have been increasing in prevalence globally. Understanding the epidemiological trends and quality measures associated with IBD can help healthcare providers improve patient outcomes and allocate resources effectively.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the case and the payer's policies. Common denials can occur if documentation does not clearly support the diagnosis of indeterminate colitis or if there is insufficient evidence of medical necessity for procedures performed. Coders should ensure that all relevant clinical notes, lab results, and imaging studies are included to support claims and reduce the risk of audits.

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 K52.3?

K52.3 covers indeterminate colitis, which includes cases of colitis that cannot be definitively classified as either Crohn's disease or ulcerative colitis. It may also encompass atypical presentations of IBD.

When should K52.3 be used instead of related codes?

K52.3 should be used when the clinical presentation suggests inflammatory bowel disease, but the specific type cannot be determined after thorough evaluation. It is crucial to document the rationale for using this code.

What documentation supports K52.3?

Documentation should include a comprehensive clinical history, results from laboratory tests, imaging studies, and endoscopic findings that support the diagnosis of indeterminate colitis, along with any treatments attempted.