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ICD-10 Guide
ICD-10 CodesK61.2

K61.2

Billable

Anorectal abscess

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

Code Description

ICD-10 K61.2 is a billable code used to indicate a diagnosis of anorectal abscess.

Key Diagnostic Point:

Anorectal abscess (K61.2) refers to a localized collection of pus in the perianal or rectal area, typically resulting from an infection of the anal glands. Clinically, patients may present with symptoms such as severe pain, swelling, and tenderness in the anal region, fever, and sometimes drainage of pus. The anatomy involved includes the anal canal, rectum, and surrounding soft tissues, particularly the anal glands that can become obstructed and infected. Disease progression can lead to the formation of a fistula if the abscess is not adequately treated, which may complicate the clinical picture. Diagnostic considerations include a thorough physical examination, often supplemented by imaging studies such as ultrasound or MRI to assess the extent of the abscess and rule out other conditions. Early diagnosis and intervention are crucial to prevent complications and facilitate healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly imaging for accurate diagnosis.
  • Treatment complexity: May involve surgical intervention for drainage and management of complications.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary for proper coding.
  • Coding specificity: Requires precise documentation of the abscess location and any associated conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the abscess type or location.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • Billing challenges: Denials may occur if the documentation does not clearly support the diagnosis and treatment provided.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Anorectal abscesses can significantly impact patient quality of life, leading to pain, discomfort, and potential complications such as fistula formation. Understanding the epidemiology of this condition is essential, as it can affect various populations, particularly those with underlying conditions such as inflammatory bowel disease. Effective management and coding of K61.2 can improve healthcare utilization patterns and enhance quality measures in gastrointestinal care.

ICD-9 vs ICD-10

Anorectal abscesses can significantly impact patient quality of life, leading to pain, discomfort, and potential complications such as fistula formation. Understanding the epidemiology of this condition is essential, as it can affect various populations, particularly those with underlying conditions such as inflammatory bowel disease. Effective management and coding of K61.2 can improve healthcare utilization patterns and enhance quality measures in gastrointestinal care.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure, the patient's insurance coverage, and the necessity of the intervention. Common denials may arise from insufficient documentation or lack of medical necessity. Best practices include ensuring that all clinical notes are complete and that the rationale for surgical intervention is clearly articulated in the medical record.

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 K61.2?

K61.2 specifically covers anorectal abscesses, which may arise from infections of the anal glands, trauma, or other underlying conditions. It does not include abscesses located elsewhere in the gastrointestinal tract.

When should K61.2 be used instead of related codes?

K61.2 should be used when the abscess is specifically located in the anorectal region and is confirmed by clinical evaluation. If the abscess is perianal or rectal, K61.0 or K61.1 may be more appropriate.

What documentation supports K61.2?

Documentation should include a detailed history of symptoms, physical examination findings, imaging results if performed, and notes on any surgical interventions or treatments administered.