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ICD-10 Guide
ICD-10 CodesK60.422

K60.422

Billable

Rectal fistula, complex, persistent

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

Code Description

ICD-10 K60.422 is a billable code used to indicate a diagnosis of rectal fistula, complex, persistent.

Key Diagnostic Point:

K60.422 refers to a complex, persistent rectal fistula, which is an abnormal connection between the rectum and the skin or another organ. Clinically, patients may present with symptoms such as persistent drainage, pain, and discomfort in the anal region. The anatomy involved includes the rectum, anal canal, and surrounding tissues, which can become inflamed or infected due to the fistula. Disease progression may involve recurrent infections, abscess formation, and complications such as fecal incontinence or skin irritation. Diagnostic considerations include a thorough clinical examination, imaging studies such as MRI or endoscopy, and possibly a fistulogram to assess the fistula's tract. Accurate diagnosis is crucial for determining the appropriate treatment plan, which may involve surgical intervention to repair the fistula and address any underlying conditions, such as Crohn's disease or diverticulitis, that may contribute to its formation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 K60.422 lies in its association with chronic gastrointestinal conditions that can affect a patient's quality of life. The population health impact includes increased healthcare utilization due to recurrent infections and the need for surgical interventions. Quality measures may focus on the successful management of fistulas and the prevention of complications. Epidemiologically, rectal fistulas are more prevalent in patients with inflammatory bowel disease, highlighting the need for targeted care and management strategies.

ICD-9 vs ICD-10

The clinical significance of K60.422 lies in its association with chronic gastrointestinal conditions that can affect a patient's quality of life. The population health impact includes increased healthcare utilization due to recurrent infections and the need for surgical interventions. Quality measures may focus on the successful management of fistulas and the prevention of complications. Epidemiologically, rectal fistulas are more prevalent in patients with inflammatory bowel disease, highlighting the need for targeted care and management strategies.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for surgical intervention is clearly documented, as well as any associated procedures. Common denials may arise from insufficient documentation or failure to demonstrate the need for complex care. Coding best practices involve using the most specific code available and ensuring that all relevant clinical information is included in the patient's medical record to support the claim.

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 K60.422?

K60.422 covers complex rectal fistulas that are persistent and may be associated with underlying conditions such as inflammatory bowel disease, trauma, or previous surgeries. Diagnostic criteria include the presence of a fistula that has not healed over time and exhibits signs of infection or drainage.

When should K60.422 be used instead of related codes?

K60.422 should be used when the rectal fistula is classified as complex and persistent, meaning it has not resolved with conservative management and may require surgical intervention. It is differentiated from simpler codes based on the complexity and chronicity of the condition.

What documentation supports K60.422?

Documentation for K60.422 should include clinical notes detailing the patient's symptoms, diagnostic imaging results, treatment history, and any surgical interventions performed. It should also reflect the complexity of the fistula and any associated conditions.