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v1.0.0
ICD-10 Guide
ICD-10 CodesK62.1

K62.1

Billable

Rectal polyp

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

Code Description

ICD-10 K62.1 is a billable code used to indicate a diagnosis of rectal polyp.

Key Diagnostic Point:

Rectal polyps are abnormal growths that arise from the rectal mucosa, which can vary in size and number. Clinically, patients may present with symptoms such as rectal bleeding, changes in bowel habits, or abdominal discomfort. The anatomy involved includes the rectum, which is the final section of the large intestine, connecting to the anal canal. Disease progression can lead to complications such as obstruction or, in some cases, malignant transformation, particularly with adenomatous polyps. Diagnostic considerations typically involve a thorough history and physical examination, followed by colonoscopy, which allows for direct visualization and potential biopsy of the polyps. Imaging studies may also be utilized to assess for additional lesions in the colon. Regular surveillance is recommended for patients with a history of polyps due to the increased risk of colorectal cancer. The identification and management of rectal polyps are crucial in preventing colorectal malignancies, emphasizing the importance of early detection and intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and histological assessment.
  • Treatment complexity: May involve polypectomy or surveillance strategies.
  • Documentation requirements: Detailed clinical notes and pathology reports are essential.
  • Coding specificity: Requires accurate coding based on the type and characteristics of the polyp.

Audit Risk Factors

  • Common coding errors: Misidentification of polyp type or location.
  • Documentation gaps: Incomplete records regarding patient history or treatment plans.
  • Billing challenges: Denials may arise from insufficient documentation or coding errors.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of rectal polyps lies in their potential progression to colorectal cancer, making early detection and management vital for population health. Regular screening and surveillance can significantly reduce the incidence of colorectal cancer, impacting healthcare utilization patterns positively. Epidemiologically, the prevalence of rectal polyps varies with age, family history, and lifestyle factors, highlighting the need for targeted screening programs in at-risk populations.

ICD-9 vs ICD-10

The clinical significance of rectal polyps lies in their potential progression to colorectal cancer, making early detection and management vital for population health. Regular screening and surveillance can significantly reduce the incidence of colorectal cancer, impacting healthcare utilization patterns positively. Epidemiologically, the prevalence of rectal polyps varies with age, family history, and lifestyle factors, highlighting the need for targeted screening programs in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance coverage and the necessity of the procedure, which should be well-documented. Common denials may occur if there is insufficient documentation to support the medical necessity of the procedure or if the coding does not align with the diagnosis. Best practices include thorough documentation of the clinical rationale for the procedure and ensuring that all relevant codes are used to capture the full scope of care provided.

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 K62.1?

K62.1 specifically covers rectal polyps, which can include hyperplastic polyps, adenomatous polyps, and sessile or pedunculated types. It does not cover polyps located in other parts of the gastrointestinal tract.

When should K62.1 be used instead of related codes?

K62.1 should be used when the polyp is specifically located in the rectum. If the polyp is found in the colon, K63.5 would be more appropriate. Accurate localization is key for proper coding.

What documentation supports K62.1?

Documentation should include the results of colonoscopy, descriptions of the polyp(s), any biopsy results, and the patient's clinical history, including symptoms and previous polyp history.