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ICD-10 Guide
ICD-10 CodesK61.5

K61.5

Billable

Supralevator abscess

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

Code Description

ICD-10 K61.5 is a billable code used to indicate a diagnosis of supralevator abscess.

Key Diagnostic Point:

Supralevator abscess is a localized collection of pus that occurs above the levator ani muscle, typically resulting from an infection in the anal region or pelvic cavity. Clinically, patients may present with severe perineal pain, fever, and signs of systemic infection. The anatomy involved includes the anal canal, rectum, and surrounding pelvic structures, which can become inflamed and infected, leading to the formation of an abscess. Disease progression can vary; if left untreated, the abscess may lead to complications such as sepsis or chronic pain. Diagnostic considerations include a thorough clinical examination, imaging studies such as ultrasound or MRI, and sometimes, surgical intervention for drainage. Early identification and management are crucial to prevent further complications and ensure optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm
  • Treatment complexity: May involve surgical intervention and post-operative care
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary
  • Coding specificity: Requires precise coding to differentiate from other abscess types

Audit Risk Factors

  • Common coding errors: Misclassification with other abscess codes
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment
  • Billing challenges: Potential denials due to lack of supporting documentation

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

Supralevator abscesses, while less common than other types of abscesses, can significantly impact patient health if not managed promptly. Their clinical significance lies in the potential for severe complications, including systemic infection and prolonged recovery times. Understanding the epidemiology of such abscesses can help healthcare providers identify at-risk populations and improve quality measures related to gastrointestinal health.

ICD-9 vs ICD-10

Supralevator abscesses, while less common than other types of abscesses, can significantly impact patient health if not managed promptly. Their clinical significance lies in the potential for severe complications, including systemic infection and prolonged recovery times. Understanding the epidemiology of such abscesses can help healthcare providers identify at-risk populations and improve quality measures related to gastrointestinal health.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity for surgical intervention. Common denials may arise from insufficient documentation or misclassification of the abscess type. Best practices include ensuring that all clinical notes are thorough and that imaging studies are clearly linked to the diagnosis.

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 K61.5?

K61.5 specifically covers supralevator abscesses, which may arise from infections in the anal region or complications from inflammatory bowel disease, diverticulitis, or trauma. Diagnostic criteria include imaging confirmation and clinical symptoms of infection.

When should K61.5 be used instead of related codes?

K61.5 should be used when the abscess is specifically located above the levator ani muscle, differentiating it from perianal or ischiorectal abscesses, which have distinct anatomical locations and management strategies.

What documentation supports K61.5?

Documentation should include clinical findings, imaging results, treatment plans, and any surgical notes if applicable. Detailed descriptions of symptoms and the location of the abscess are essential for accurate coding.