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ICD-10 Guide
ICD-10 CodesK62.7

K62.7

Billable

Radiation proctitis

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

Code Description

ICD-10 K62.7 is a billable code used to indicate a diagnosis of radiation proctitis.

Key Diagnostic Point:

Radiation proctitis is an inflammatory condition of the rectum that occurs as a result of radiation therapy, primarily used in the treatment of pelvic malignancies such as prostate, cervical, or rectal cancer. Clinically, patients may present with symptoms including rectal bleeding, diarrhea, urgency, and tenesmus. The anatomy involved includes the rectal mucosa, which becomes damaged due to radiation exposure, leading to mucosal inflammation and ulceration. Disease progression can vary; acute radiation proctitis typically occurs within weeks of radiation exposure, while chronic radiation proctitis may develop months to years later, characterized by persistent symptoms and potential complications such as strictures or fistulas. Diagnostic considerations include a thorough patient history, physical examination, and possibly endoscopic evaluation to assess the extent of mucosal damage and rule out other causes of rectal symptoms. Biopsy may be performed to confirm the diagnosis and assess for any malignancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other causes of rectal symptoms.
  • Treatment complexity: Management may involve medications, dietary changes, or surgical interventions.
  • Documentation requirements: Detailed documentation of symptoms, treatment history, and response to therapy is essential.
  • Coding specificity: Requires accurate coding to reflect the specific nature of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification with other gastrointestinal conditions.
  • Documentation gaps: Incomplete records of radiation history or symptomatology.
  • Billing challenges: Potential denials if the link between radiation therapy and symptoms is not clearly established.

Specialty Focus

Medical Specialties

Oncology

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

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

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

Radiation proctitis significantly impacts patient quality of life, leading to increased healthcare utilization due to frequent medical visits and potential interventions. Understanding this condition is crucial for improving population health outcomes, as it affects a subset of cancer survivors who may experience long-term gastrointestinal complications. Quality measures should focus on effective management strategies to alleviate symptoms and improve patient satisfaction.

ICD-9 vs ICD-10

Radiation proctitis significantly impacts patient quality of life, leading to increased healthcare utilization due to frequent medical visits and potential interventions. Understanding this condition is crucial for improving population health outcomes, as it affects a subset of cancer survivors who may experience long-term gastrointestinal complications. Quality measures should focus on effective management strategies to alleviate symptoms and improve patient satisfaction.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the treatment provided. Common denials may arise if there is insufficient documentation to support the diagnosis or if the treatment is not adequately justified. Best practices include maintaining comprehensive records of all patient interactions, treatment plans, and responses to therapy, as well as ensuring that coding accurately reflects the patient's condition and treatment course.

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 K62.7?

K62.7 specifically covers radiation proctitis, which includes both acute and chronic forms of rectal inflammation resulting from radiation therapy. It does not encompass other rectal conditions unless they are directly related to radiation exposure.

When should K62.7 be used instead of related codes?

K62.7 should be used when the patient's rectal symptoms are directly attributable to prior radiation therapy. It is important to differentiate from other gastrointestinal disorders that may present similarly but are not related to radiation exposure.

What documentation supports K62.7?

Documentation should include a detailed history of radiation therapy, symptom onset and duration, any prior treatments, and results from diagnostic procedures such as colonoscopy or imaging studies that confirm the diagnosis of radiation proctitis.