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2025 ICD-10-CM code K51.013

Ulcerative (chronic) pancolitis with fistula.

Accurate coding requires complete documentation of the patient's symptoms, diagnostic findings, and treatment plan.The presence of a fistula should be clearly documented and supported by imaging studies.

Modifiers are not applicable to ICD-10 codes.Modifiers are used with CPT and HCPCS codes.

Medical necessity for coding K51.013 is established by the presence of clinically significant symptoms and findings consistent with ulcerative colitis and the presence of a fistula, requiring appropriate medical management to alleviate symptoms and prevent complications.

The clinical responsibility for managing a patient with K51.013 would typically involve gastroenterologists, surgeons (if surgical intervention is required), and other specialists as needed for managing complications (e.g., infectious disease specialist for fistula infection).

IMPORTANT:Related codes might include those specifying other complications of ulcerative colitis (e.g., rectal bleeding (K51.011), intestinal obstruction (K51.012), abscess (K51.014)).The appropriate code should reflect the complete clinical picture.

In simple words: This code describes a serious type of inflammatory bowel disease where the entire large intestine is inflamed and has sores.There's also an abnormal connection between parts of the bowel, which needs special medical attention.

This ICD-10-CM code classifies ulcerative colitis, a chronic inflammatory bowel disease affecting the large intestine and rectum, specifically characterized by pancolitis (inflammation of the entire colon) and the presence of a fistula (an abnormal connection between two organs or vessels).The inflammation causes ulceration of the colon's lining, leading to symptoms such as abdominal pain, diarrhea, rectal bleeding, and potentially more severe complications. A fistula adds another layer of complexity and requires specific medical management.

Example 1: A 35-year-old female presents with chronic diarrhea, abdominal pain, and rectal bleeding. Colonoscopy reveals pancolitis with a perianal fistula. Code K51.013 is used to accurately reflect the diagnosis., A 28-year-old male with a history of ulcerative colitis experiences worsening symptoms, including a new perirectal abscess and fistula.Surgical intervention is required for fistula repair, and K51.013 is used to accurately code the underlying condition., A 42-year-old female with a long history of ulcerative colitis develops a fistula that becomes infected, requiring antibiotic treatment and surgical intervention.The combination of the underlying condition and complication is accurately coded with K51.013.

Detailed clinical history, including symptom onset, duration, and severity.Complete physical examination findings.Results of relevant laboratory tests (e.g., complete blood count, inflammatory markers).Imaging studies (e.g., colonoscopy, abdominal CT scan) demonstrating the extent of colitis and presence of fistula.Documentation of any surgical interventions or other treatments.

** The severity of ulcerative colitis and the presence of complications (such as fistula) impact treatment decisions and prognosis.Accurate coding is crucial for appropriate reimbursement and tracking of healthcare utilization.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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iFrame™ AI's knowledge is aligned with and limited to the materials uploaded by users and should not be interpreted as medical, legal, or any other form of advice by iFrame™.