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ICD-10 Guide
ICD-10 CodesK60.313

K60.313

Billable

Anal fistula, simple, recurrent

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

Code Description

ICD-10 K60.313 is a billable code used to indicate a diagnosis of anal fistula, simple, recurrent.

Key Diagnostic Point:

K60.313 refers to a simple, recurrent anal fistula, which is an abnormal connection between the anal canal and the skin surrounding the anus. Clinically, patients may present with symptoms such as pain, swelling, and discharge, often exacerbated by bowel movements. The anatomy involved includes the anal sphincter complex and surrounding tissues, which can become inflamed or infected, leading to the formation of the fistula. Disease progression typically involves recurrent episodes of infection and inflammation, which can complicate treatment and lead to chronic discomfort. Diagnostic considerations include a thorough clinical examination, possibly supplemented by imaging studies such as MRI or endoanal ultrasound to assess the fistula's tract and any associated abscesses. Accurate diagnosis is crucial for determining the appropriate surgical intervention and managing recurrence effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment to differentiate from other anal conditions.
  • Treatment complexity: Surgical options vary based on fistula type and recurrence.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise coding to reflect the recurrent nature of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of fistula type or recurrence status.
  • Documentation gaps: Incomplete clinical notes or lack of imaging documentation.
  • Billing challenges: Potential denials due to insufficient evidence of recurrence or treatment rationale.

Specialty Focus

Medical Specialties

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

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

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

The clinical significance of K60.313 lies in its impact on patient quality of life, as recurrent anal fistulas can lead to chronic pain and discomfort. From a population health perspective, understanding the prevalence and management of anal fistulas can inform healthcare utilization patterns and guide preventive measures. Epidemiologically, recurrent anal fistulas may indicate underlying conditions such as Crohn's disease, necessitating a comprehensive approach to patient care and management.

ICD-9 vs ICD-10

The clinical significance of K60.313 lies in its impact on patient quality of life, as recurrent anal fistulas can lead to chronic pain and discomfort. From a population health perspective, understanding the prevalence and management of anal fistulas can inform healthcare utilization patterns and guide preventive measures. Epidemiologically, recurrent anal fistulas may indicate underlying conditions such as Crohn's disease, necessitating a comprehensive approach to patient care and management.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, the patient's insurance coverage, and the necessity of supporting documentation. Common denials may arise from insufficient evidence of recurrence or lack of detailed clinical notes. Best practices include ensuring thorough documentation of the patient's history, treatment rationale, and any imaging studies performed to support the diagnosis and treatment plan.

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 K60.313?

K60.313 specifically covers simple anal fistulas that are recurrent. This includes cases where the fistula has previously healed but has reopened, leading to similar symptoms as the initial presentation.

When should K60.313 be used instead of related codes?

K60.313 should be used when the anal fistula is confirmed to be simple in nature but has recurred. If the fistula is complex or has additional complications, other codes such as K60.32 should be considered.

What documentation supports K60.313?

Documentation should include a detailed history of the patient's symptoms, previous treatments, clinical examination findings, and any imaging studies that confirm the diagnosis of a recurrent simple anal fistula.