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ICD-10 Guide
ICD-10 CodesK63.3

K63.3

Billable

Ulcer of intestine

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

Code Description

ICD-10 K63.3 is a billable code used to indicate a diagnosis of ulcer of intestine.

Key Diagnostic Point:

K63.3 refers to an ulcer of the intestine, which is a localized area of tissue breakdown in the intestinal lining. This condition can occur in various parts of the intestine, including the small intestine and colon. Clinically, patients may present with symptoms such as abdominal pain, gastrointestinal bleeding, changes in bowel habits, and weight loss. The anatomy involved typically includes the mucosal layer of the intestine, which can become inflamed and eroded due to various factors including infection, medication (such as NSAIDs), or underlying diseases like Crohn's disease. Disease progression can lead to complications such as perforation, peritonitis, or intestinal obstruction if not properly managed. Diagnostic considerations include endoscopy, imaging studies, and laboratory tests to assess for anemia or infection. A thorough patient history and physical examination are essential for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis to rule out other gastrointestinal disorders.
  • Treatment complexity: May involve medication management, dietary changes, or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal ulcers.

Audit Risk Factors

  • Common coding errors: Misclassification with other gastrointestinal conditions.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Denials due to lack of clear linkage between diagnosis and treatment.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K63.3 lies in its potential complications, which can lead to increased healthcare utilization and costs. Understanding the epidemiology of intestinal ulcers is crucial for population health, as these conditions can affect a significant portion of the population, particularly those with risk factors such as chronic NSAID use or inflammatory bowel disease. Quality measures related to timely diagnosis and effective management of intestinal ulcers can improve patient outcomes and reduce hospitalizations.

ICD-9 vs ICD-10

The clinical significance of K63.3 lies in its potential complications, which can lead to increased healthcare utilization and costs. Understanding the epidemiology of intestinal ulcers is crucial for population health, as these conditions can affect a significant portion of the population, particularly those with risk factors such as chronic NSAID use or inflammatory bowel disease. Quality measures related to timely diagnosis and effective management of intestinal ulcers can improve patient outcomes and reduce hospitalizations.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the treatment provided. Common denials may arise from insufficient documentation linking the diagnosis to the treatment plan. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the patient's condition and the services rendered. Regular audits can help identify areas for improvement in documentation and coding accuracy.

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 K63.3?

K63.3 encompasses ulcers of the intestine, which may arise from various etiologies including peptic ulcers, ischemic ulcers, and ulcers associated with inflammatory bowel disease. It is essential to differentiate these from other gastrointestinal conditions such as diverticulitis or colorectal cancer.

When should K63.3 be used instead of related codes?

K63.3 should be used when there is clear evidence of an ulcerative condition in the intestine, particularly when symptoms and diagnostic findings support this diagnosis. It is important to avoid using this code when the condition is more accurately described by another code, such as K63.1 for polyps.

What documentation supports K63.3?

Documentation should include a detailed patient history, physical examination findings, results from imaging studies or endoscopy, and any laboratory tests that indicate the presence of an ulcer. Clinical notes must clearly outline the symptoms, diagnosis, and treatment plan.