2025 ICD-10-CM code K51.213
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Noninfective enteritis and colitis - Ulcerative (chronic) proctitis Diseases of the digestive system (K00-K95) Feed
Ulcerative (chronic) proctitis with fistula.
Modifiers may be applicable depending on the circumstances of the encounter. Consult the official CPT and ICD-10-CM guidelines for appropriate modifier usage.
Medical necessity for coding K51.213 is established through proper documentation supporting the diagnosis of ulcerative proctitis and the presence of a fistula. The symptoms, diagnostic findings, and the impact on the patient's quality of life should justify the use of this code.Payer-specific guidelines regarding medical necessity should also be considered.
The clinical responsibility includes the diagnosis and management of ulcerative proctitis and any associated fistula. This may involve performing a physical examination, reviewing medical history, ordering diagnostic tests (e.g., colonoscopy, biopsy), and initiating appropriate treatment (e.g., medication, surgery).
In simple words: This code describes a type of chronic inflammation in the rectum (the end part of the large intestine) that has caused an abnormal connection or tunnel to develop. This connection might be to another organ or to the skin near the rectum.
This ICD-10-CM code classifies ulcerative proctitis, a chronic inflammatory condition affecting the rectum, specifically when it's 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 likely represents an abnormal connection originating from the inflamed rectal tissue.
Example 1: A 45-year-old female presents with chronic rectal bleeding, abdominal pain, and tenesmus. Colonoscopy reveals ulcerative proctitis, and a perianal fistula is identified.Code K51.213 is used to bill for the diagnosis., A 60-year-old male with a history of ulcerative proctitis experiences worsening symptoms, including a palpable perirectal mass. Imaging confirms the presence of a perianal fistula.Code K51.213 is applied in conjunction with codes describing the fistula., A 32-year-old female diagnosed with ulcerative proctitis undergoes surgical repair of a recto-vaginal fistula (abnormal connection between the rectum and vagina). Code K51.213 is applied along with procedural codes for the surgical intervention.
Complete medical history, physical examination findings, relevant lab results (e.g., inflammatory markers), and imaging studies (e.g., MRI, CT scan) confirming the diagnosis of ulcerative proctitis and the presence of a fistula. Detailed documentation of fistula location, size, and any associated complications.Operative notes or other documentation for any surgical procedures.
** Accurate documentation is crucial for proper coding and reimbursement.Clinical judgement is required to select the most appropriate code based on the specific clinical picture. Always refer to the latest coding guidelines and payer-specific requirements.
- Payment Status: Active
- Modifier TC rule: Not applicable for this diagnosis code.
- Specialties:Gastroenterology, Colorectal Surgery, General Surgery
- Place of Service:Office, Hospital (inpatient or outpatient), Ambulatory Surgical Center