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ICD-10 Guide
ICD-10 CodesK62.6

K62.6

Billable

Ulcer of anus and rectum

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

Code Description

ICD-10 K62.6 is a billable code used to indicate a diagnosis of ulcer of anus and rectum.

Key Diagnostic Point:

K62.6 refers to ulcers of the anus and rectum, which are lesions that can occur in the anal canal or rectal mucosa. These ulcers may present with symptoms such as pain, bleeding, and discomfort during bowel movements. The anatomy involved includes the anal sphincter, rectal mucosa, and surrounding tissues. Disease progression can vary; acute ulcers may arise from trauma, infections, or inflammatory bowel diseases, while chronic ulcers may be associated with conditions like Crohn's disease or malignancies. Diagnostic considerations include a thorough patient history, physical examination, and potentially endoscopic evaluation to assess the extent and cause of the ulceration. Laboratory tests may also be warranted to rule out infections or other underlying conditions. Proper identification and management of these ulcers are crucial to prevent complications such as abscess formation or fistula development.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to determine underlying causes.
  • Treatment complexity: May involve medical management, dietary changes, or surgical intervention.
  • Documentation requirements: Detailed clinical notes and diagnostic tests are necessary.
  • Coding specificity: Requires accurate coding to differentiate from other gastrointestinal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other anal or rectal conditions.
  • Documentation gaps: Incomplete records regarding the patient's history and treatment.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

The clinical significance of K62.6 lies in its potential to indicate underlying gastrointestinal disorders that may affect a patient's quality of life. The prevalence of anal and rectal ulcers can impact population health, as they may lead to complications if not properly managed. Quality measures related to this condition often focus on timely diagnosis and effective treatment strategies, which can influence healthcare utilization patterns and overall patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K62.6 lies in its potential to indicate underlying gastrointestinal disorders that may affect a patient's quality of life. The prevalence of anal and rectal ulcers can impact population health, as they may lead to complications if not properly managed. Quality measures related to this condition often focus on timely diagnosis and effective treatment strategies, which can influence healthcare utilization patterns and overall patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical evidence and that all relevant procedures are coded accurately. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining thorough records and ensuring that all services rendered are clearly linked to the diagnosis of an anal or rectal ulcer.

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 K62.6?

K62.6 encompasses various types of ulcers affecting the anus and rectum, including those caused by inflammatory bowel disease, infections, trauma, or malignancies. It is essential to differentiate these from other anal conditions such as fissures or hemorrhoids.

When should K62.6 be used instead of related codes?

K62.6 should be used when the primary diagnosis is an ulcer of the anus or rectum, particularly when there is clear documentation of ulceration rather than other conditions like fissures or hemorrhoids, which have their own specific codes.

What documentation supports K62.6?

Documentation should include a detailed patient history, physical examination findings, results from any imaging or endoscopic studies, and treatment plans. Clear notes indicating the diagnosis of an ulcer and its etiology are crucial.