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v1.0.0
ICD-10 Guide
ICD-10 CodesK64.0

K64.0

Billable

First degree hemorrhoids

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

Code Description

ICD-10 K64.0 is a billable code used to indicate a diagnosis of first degree hemorrhoids.

Key Diagnostic Point:

First degree hemorrhoids, classified under K64.0 in the ICD-10 coding system, refer to hemorrhoids that are characterized by the presence of swollen veins in the rectal area that do not prolapse outside the anal canal. Clinically, patients may present with symptoms such as mild discomfort, itching, and occasional bleeding during bowel movements. The anatomy involved includes the anal canal and the surrounding vascular structures, particularly the inferior rectal veins. Disease progression can lead to increased swelling and discomfort, potentially advancing to second or third-degree hemorrhoids if left untreated. Diagnostic considerations include a thorough patient history, physical examination, and possibly anoscopy to assess the severity of the condition. It is essential to differentiate first-degree hemorrhoids from other gastrointestinal conditions such as anal fissures or more severe hemorrhoidal disease to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - straightforward diagnosis based on clinical presentation
  • Treatment complexity: Low - often managed with conservative measures
  • Documentation requirements: Moderate - requires clear documentation of symptoms and examination findings
  • Coding specificity: Low - specific to first-degree hemorrhoids

Audit Risk Factors

  • Common coding errors: Misclassification of degree of hemorrhoids
  • Documentation gaps: Incomplete symptom description or lack of examination findings
  • Billing challenges: Denials due to insufficient documentation or incorrect code selection

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

First-degree hemorrhoids, while often a benign condition, can significantly impact patient quality of life due to discomfort and associated symptoms. Understanding the prevalence of hemorrhoids in the population can inform healthcare providers about the need for effective management strategies. Quality measures may include patient education on lifestyle modifications to prevent progression of hemorrhoids, which can lead to increased healthcare utilization if not addressed early.

ICD-9 vs ICD-10

First-degree hemorrhoids, while often a benign condition, can significantly impact patient quality of life due to discomfort and associated symptoms. Understanding the prevalence of hemorrhoids in the population can inform healthcare providers about the need for effective management strategies. Quality measures may include patient education on lifestyle modifications to prevent progression of hemorrhoids, which can lead to increased healthcare utilization if not addressed early.

Reimbursement & Billing Impact

Reimbursement considerations include the use of appropriate CPT codes for any procedures performed, such as hemorrhoidectomy if indicated. Common denials may arise from insufficient documentation or incorrect coding, so it is crucial to ensure that all clinical evidence is clearly recorded. Best practices include verifying insurance coverage for hemorrhoid treatments and ensuring that all claims are submitted with accurate and specific codes.

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 K64.0?

K64.0 specifically covers first-degree hemorrhoids, which are characterized by the presence of hemorrhoids that do not protrude outside the anal canal. Symptoms may include mild discomfort, itching, and occasional bleeding.

When should K64.0 be used instead of related codes?

K64.0 should be used when the hemorrhoids are first-degree, meaning they are present but do not prolapse. If the hemorrhoids are prolapsed or more severe, codes K64.1 or K64.2 should be considered.

What documentation supports K64.0?

Documentation should include a detailed patient history, physical examination findings, and any relevant diagnostic tests that confirm the presence of first-degree hemorrhoids without prolapse.