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v1.0.0
ICD-10 Guide
ICD-10 CodesK62.3

K62.3

Billable

Rectal prolapse

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

Code Description

ICD-10 K62.3 is a billable code used to indicate a diagnosis of rectal prolapse.

Key Diagnostic Point:

Rectal prolapse is a condition characterized by the protrusion of the rectal wall through the anal opening, which can occur in varying degrees of severity. Clinically, patients may present with symptoms such as a visible bulge from the anus, rectal bleeding, discomfort, and fecal incontinence. The anatomy involved includes the rectum, anal sphincters, and surrounding connective tissues, which may weaken due to factors such as age, childbirth, chronic constipation, or neurological conditions. Disease progression can lead to complications such as strangulation of the prolapsed tissue, which may necessitate surgical intervention. Diagnostic considerations include a thorough physical examination, patient history, and possibly imaging studies to assess the extent of the prolapse and rule out other gastrointestinal disorders. It is essential for healthcare providers to differentiate between full-thickness and partial-thickness prolapse, as this can influence treatment options and prognosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment to differentiate from other conditions.
  • Treatment complexity: May involve conservative management or surgical options depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis.
  • Coding specificity: Requires accurate coding to reflect the specific type and severity of prolapse.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of prolapse or failure to document severity.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis or treatment plan.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect code selection.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Rectal prolapse can significantly affect a patient's quality of life, leading to discomfort, social embarrassment, and potential complications if left untreated. It is more prevalent in older adults and individuals with a history of childbirth or chronic constipation. Understanding the epidemiology of rectal prolapse can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include tracking surgical outcomes and patient satisfaction, which can inform healthcare utilization patterns and improve overall care for affected individuals.

ICD-9 vs ICD-10

Rectal prolapse can significantly affect a patient's quality of life, leading to discomfort, social embarrassment, and potential complications if left untreated. It is more prevalent in older adults and individuals with a history of childbirth or chronic constipation. Understanding the epidemiology of rectal prolapse can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include tracking surgical outcomes and patient satisfaction, which can inform healthcare utilization patterns and improve overall care for affected individuals.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the procedure performed, and providers should stay updated on payer policies regarding rectal prolapse treatments to minimize billing challenges.

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 K62.3?

K62.3 specifically covers rectal prolapse, which can be classified into complete and incomplete prolapse. It does not include other forms of rectal disorders such as rectal bleeding or rectal ulcers.

When should K62.3 be used instead of related codes?

K62.3 should be used when there is a clear diagnosis of rectal prolapse, particularly when the patient exhibits symptoms of protrusion or other complications. It is important to differentiate it from other gastrointestinal conditions that may present with similar symptoms.

What documentation supports K62.3?

Documentation should include a detailed patient history, physical examination findings, and any imaging studies performed. Notes should clearly describe the nature of the prolapse, associated symptoms, and any treatment plans discussed.