ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK60.50

K60.50

Billable

Anorectal fistula, unspecified

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

Code Description

ICD-10 K60.50 is a billable code used to indicate a diagnosis of anorectal fistula, unspecified.

Key Diagnostic Point:

Anorectal fistula, unspecified, is a pathological connection between the anal canal and the perianal skin, often resulting from an abscess or inflammatory process. Clinically, patients may present with symptoms such as pain, swelling, and discharge in the anal region. The anatomy involved includes the anal sphincter complex and surrounding tissues, which can be affected by various gastrointestinal conditions, including Crohn's disease, diverticulitis, or prior surgical interventions. Disease progression can lead to recurrent infections and complications if left untreated. Diagnosis typically involves a thorough clinical examination, including digital rectal examination and possibly imaging studies like MRI or endoscopy to assess the fistula's extent and complexity. Accurate diagnosis is crucial for determining the appropriate treatment plan, which may involve surgical intervention to repair the fistula and manage any underlying conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation to differentiate from other anorectal conditions.
  • Treatment complexity: Surgical options vary based on fistula type and underlying causes.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise coding to reflect the specific nature of the fistula.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of fistula.
  • Documentation gaps: Incomplete clinical notes leading to unclear diagnosis.
  • Billing challenges: Potential denials due to lack of specificity in coding.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Anorectal fistulas can significantly impact patient quality of life, leading to discomfort, social stigma, and potential complications if untreated. Understanding the epidemiology of this condition is crucial, as it affects a diverse population, with varying incidence rates based on underlying gastrointestinal diseases. Effective management and coding of K60.50 can improve healthcare utilization patterns and enhance quality measures in gastrointestinal care.

ICD-9 vs ICD-10

Anorectal fistulas can significantly impact patient quality of life, leading to discomfort, social stigma, and potential complications if untreated. Understanding the epidemiology of this condition is crucial, as it affects a diverse population, with varying incidence rates based on underlying gastrointestinal diseases. Effective management and coding of K60.50 can improve healthcare utilization patterns and enhance quality measures in gastrointestinal care.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the fistula and the surgical interventions required. Common denials may arise from insufficient documentation or incorrect coding. Best practices include ensuring that all clinical notes are thorough and that the coding accurately reflects the patient's condition and treatment plan. It is also advisable to verify insurance coverage for specific procedures related to anorectal fistulas.

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 K60.50?

K60.50 covers unspecified anorectal fistulas, which may arise from various conditions such as abscesses, inflammatory bowel disease, or trauma. It is important to note that this code does not specify the type or complexity of the fistula.

When should K60.50 be used instead of related codes?

K60.50 should be used when the specific type of anorectal fistula is not documented. If the type is known, such as intersphincteric or transsphincteric, the corresponding specific codes (K60.51 or K60.52) should be utilized.

What documentation supports K60.50?

Documentation should include a detailed clinical history, physical examination findings, imaging results if performed, and any relevant laboratory tests. Clear notes on the patient's symptoms and the clinical rationale for the diagnosis are essential.