ICD-10 Coding for Hyperplastic Polyp(K63.5, D12.7)
Complete ICD-10-CM coding and documentation guide for Hyperplastic Polyp. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hyperplastic Polyp
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K63.5 | Polyp of colon | Use for confirmed hyperplastic polyps without adenomatous changes. |
|
| D12.7 | Benign neoplasm of rectosigmoid junction | Use for hyperplastic polyps with adenomatous changes or located in the rectosigmoid. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hyperplastic polyp
Essential facts and insights about Hyperplastic Polyp
Primary ICD-10-CM Codes for hyperplastic polyp
Decision Criteria
clinical Criteria
- Pathology report must specify 'hyperplastic'.
coding Criteria
- Do not use if adenomatous changes are present.
Applicable To
- Hyperplastic polyp of colon
Excludes
- Adenomatous polyp (D12.x)
Clinical Validation Requirements
- Pathology report confirming hyperplastic nature
- Colonoscopy report specifying location
Code-Specific Risks
- Misclassification as adenomatous polyp
Coding Notes
- Ensure pathology confirms hyperplastic nature before coding.
D12.7 - Benign neoplasm of rectosigmoid junction
Use for hyperplastic polyps with adenomatous changes or located in the rectosigmoid.
Applicable To
- Adenomatous polyp of rectosigmoid
Excludes
- Hyperplastic polyp without adenomatous changes (K63.5)
Clinical Validation Requirements
- Pathology report indicating adenomatous changes
- Colonoscopy report specifying rectosigmoid location
Coding Notes
Ensure adenomatous changes are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hyperplastic Polyp to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K63.5.
Impact
Clinical: May lead to inappropriate surveillance intervals., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Always document the specific location of the polyp., Cross-check endoscopy and pathology reports.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data on polyp types.
Mitigation Strategy
Verify pathology report specifies 'hyperplastic'.
Impact
Failure to confirm histology can lead to incorrect coding.
Mitigation Strategy
Implement a checklist for pathology report review before coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hyperplastic Polyp, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hyperplastic Polyp
Use these documentation templates to ensure complete and accurate documentation for Hyperplastic Polyp. These templates include all required elements for proper coding and billing.
Screening colonoscopy with hyperplastic polyp
Specialty: GastroenterologyRequired Elements
- Indication for procedure
- Findings including polyp size and location
- Pathology results
- Surveillance recommendations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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