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ICD-10 Guide
ICD-10 CodesK63.2

K63.2

Billable

Fistula of intestine

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

Code Description

ICD-10 K63.2 is a billable code used to indicate a diagnosis of fistula of intestine.

Key Diagnostic Point:

A fistula of the intestine is an abnormal connection between the intestinal lumen and another structure, which may include other parts of the gastrointestinal tract, the skin, or adjacent organs. Clinically, patients may present with symptoms such as diarrhea, abdominal pain, malnutrition, and signs of infection. The anatomy involved typically includes the small intestine or large intestine, where the fistula can form due to conditions like Crohn's disease, diverticulitis, or post-surgical complications. Disease progression can lead to significant morbidity, including electrolyte imbalances and sepsis if not managed properly. Diagnostic considerations include imaging studies such as CT scans or MRI, endoscopy, and sometimes exploratory surgery to confirm the presence and extent of the fistula. Early diagnosis and intervention are crucial to prevent complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

General 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 K63.2 lies in its potential to lead to severe complications if not addressed promptly. Population health impact includes increased healthcare utilization due to hospitalizations and surgeries related to fistula management. Quality measures may focus on timely diagnosis and treatment to reduce complications. Epidemiologically, the prevalence of intestinal fistulas is often associated with underlying gastrointestinal diseases, highlighting the need for effective management strategies.

ICD-9 vs ICD-10

The clinical significance of K63.2 lies in its potential to lead to severe complications if not addressed promptly. Population health impact includes increased healthcare utilization due to hospitalizations and surgeries related to fistula management. Quality measures may focus on timely diagnosis and treatment to reduce complications. Epidemiologically, the prevalence of intestinal fistulas is often associated with underlying gastrointestinal diseases, highlighting the need for effective management strategies.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the treatment provided. Common denials may arise from insufficient documentation or lack of specificity in coding. Best practices include thorough documentation of the patient's condition and any related procedures performed, ensuring that all services are justified and coded accurately to avoid 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 K63.2?

K63.2 covers various types of intestinal fistulas, including those resulting from inflammatory bowel disease, surgical complications, or trauma. It is essential to document the underlying cause and the specific location of the fistula for accurate coding.

When should K63.2 be used instead of related codes?

K63.2 should be used when the fistula specifically involves the intestine and is not associated with other structures or conditions that would warrant a different code. Accurate differentiation is crucial for proper coding and reimbursement.

What documentation supports K63.2?

Documentation should include clinical notes detailing the patient's symptoms, diagnostic imaging results, surgical reports if applicable, and any underlying conditions contributing to the fistula formation.