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v1.0.0
ICD-10 Guide
ICD-10 CodesK63.5

K63.5

Billable

Polyp of colon

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

Code Description

ICD-10 K63.5 is a billable code used to indicate a diagnosis of polyp of colon.

Key Diagnostic Point:

Polyp of the colon refers to a growth that arises from the lining of the colon (large intestine) and protrudes into the lumen. These polyps can vary in size, shape, and histological type, including adenomatous, hyperplastic, and sessile types. Clinically, patients may be asymptomatic or present with symptoms such as rectal bleeding, changes in bowel habits, or abdominal pain. The anatomy involved primarily includes the colon, which is divided into several segments: ascending, transverse, descending, and sigmoid colon. Disease progression can lead to complications such as obstruction or, in some cases, malignant transformation, particularly with adenomatous polyps. Diagnostic considerations include colonoscopy, which allows for direct visualization and potential biopsy of polyps, as well as imaging studies like CT colonography. Regular screening is recommended, especially for individuals over 50 or those with a family history of colorectal cancer, to detect polyps early and prevent progression to cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and histological assessment.
  • Treatment complexity: May involve polypectomy or surveillance strategies.
  • Documentation requirements: Detailed clinical documentation of findings and treatment plans is essential.
  • Coding specificity: Requires accurate coding based on the type and characteristics of the polyp.

Audit Risk Factors

  • Common coding errors: Misclassification of polyp type or failure to document size and histology.
  • Documentation gaps: Incomplete records regarding patient history or follow-up care.
  • Billing challenges: Denials may occur if documentation does not support the medical necessity of procedures.

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 K63.5 lies in its association with colorectal cancer prevention. Early detection and removal of polyps can significantly reduce the incidence of colorectal cancer, impacting population health positively. Quality measures often include screening rates for colorectal cancer, which are crucial for healthcare utilization patterns. Epidemiologically, the prevalence of colon polyps varies with age, lifestyle factors, and genetic predispositions, making awareness and screening essential in at-risk populations.

ICD-9 vs ICD-10

The clinical significance of K63.5 lies in its association with colorectal cancer prevention. Early detection and removal of polyps can significantly reduce the incidence of colorectal cancer, impacting population health positively. Quality measures often include screening rates for colorectal cancer, which are crucial for healthcare utilization patterns. Epidemiologically, the prevalence of colon polyps varies with age, lifestyle factors, and genetic predispositions, making awareness and screening essential in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of colonoscopy for diagnosis and any subsequent polypectomy. Common denials may arise from inadequate documentation of the medical necessity for procedures or failure to provide complete clinical information. Best practices include thorough documentation of patient history, procedure details, and follow-up care to support claims and reduce audit risks.

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 K63.5?

K63.5 specifically covers polyps of the colon, including various histological types such as adenomatous and hyperplastic polyps. It does not include malignant tumors or polyps located in other parts of the gastrointestinal tract.

When should K63.5 be used instead of related codes?

K63.5 should be used when a colon polyp is identified during diagnostic procedures. It is essential to differentiate it from codes for other gastrointestinal conditions, such as K63.4, which refers to other types of polyps, or K62.1 for rectal polyps.

What documentation supports K63.5?

Documentation should include the results of colonoscopy, descriptions of the polyp's size, type, and location, as well as any histopathological findings. Follow-up plans and patient history related to colorectal cancer screening should also be documented.