2025 ICD-10-CM code K51.413
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Gastrointestinal Diseases - Inflammatory polyps of colon with complications Diseases of the digestive system Feed
This code describes inflammatory polyps in the colon accompanied by a fistula.
Medical necessity for coding K51.413 is established by the presence of clinically significant symptoms (e.g., abdominal pain, bleeding, fever, palpable mass) related to the inflammatory polyps and fistula. The physician must document the medical necessity for any diagnostic or therapeutic procedures performed to manage this condition. The procedures should be appropriate based on the patient's clinical presentation, and comply with relevant guidelines and regulations.
The clinical responsibility for coding K51.413 falls on the physician or qualified healthcare professional who diagnoses and manages the patient's condition. This includes performing appropriate diagnostic tests (e.g., colonoscopy, imaging studies) to confirm the diagnosis and determine the extent of the disease, managing the patient's symptoms, and coordinating care with other specialists if necessary.
In simple words: This code is used when a person has inflamed growths (polyps) in their large intestine (colon) and an abnormal connection (fistula) between the colon and another part of the body.
K51.413, Inflammatory polyps of colon with fistula, is an ICD-10-CM code that classifies inflammatory polyps in the colon complicated by the presence of a fistula.A fistula is an abnormal connection between two organs or between an organ and the body surface. In this context, it indicates an abnormal passage from the colon to another structure, such as another part of the digestive tract or the skin.The code requires documentation specifying the location of the polyps and the presence of the fistula.It excludes adenomatous polyps, polyposis of the colon, and polyps of the colon not otherwise specified.
Example 1: A 60-year-old patient presents with abdominal pain, bloody stool, and a palpable mass. Colonoscopy reveals inflammatory polyps in the sigmoid colon with a fistula to the adjacent small bowel.The patient undergoes surgical resection of the affected colon segment and fistula repair., A 45-year-old female with a history of inflammatory bowel disease experiences recurrent abdominal pain and fever.Imaging studies show inflammatory polyps in the transverse colon with a fistula draining to the abdominal wall. The patient is treated with antibiotics and undergoes percutaneous drainage of the fistula., A 72-year-old male undergoes a routine colonoscopy which reveals multiple inflammatory polyps in the descending colon, one of which is associated with a small fistula to the bladder. Further investigation is warranted to determine appropriate management.
Documentation should include the results of colonoscopy or other imaging studies clearly demonstrating the presence and location of the inflammatory polyps and the fistula.Details about the fistula, including its location, extent, and any associated complications, should be recorded.If surgical intervention is performed, operative notes should be comprehensive. The clinical findings supporting the diagnosis of inflammatory polyps and fistula should be clearly documented.
** Further investigation may be required to determine the etiology of the inflammatory polyps and fistula.Management may involve medical therapy (e.g., anti-inflammatory medications) or surgical intervention (e.g., resection of the affected bowel segment, fistula repair).
- Payment Status: Active
- Specialties:Gastroenterology, Colorectal Surgery, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center