ICD-10 Coding for Polyp(D12.0, K63.5, K51.4)
Complete ICD-10-CM coding and documentation guide for Polyp. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Polyp
D12Primary Range
Benign neoplasm of colon, rectum, anus and anal canal
Primary range for adenomatous polyps, which require surveillance due to neoplastic potential.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D12.0 | Benign neoplasm of cecum | Use when pathology confirms adenomatous polyp in the cecum. |
|
| K63.5 | Polyp of colon | Use when the polyp is hyperplastic or histology is unspecified. |
|
| K51.4 | Inflammatory polyps of colon | Use when polyps are associated with inflammatory bowel disease. |
|
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 adenomatous polyp
Essential facts and insights about Polyp
Primary ICD-10-CM Codes for polyp
Decision Criteria
clinical Criteria
- Confirmed adenomatous histology from pathology
Applicable To
- Adenomatous polyp of cecum
Excludes
- Hyperplastic polyp of cecum (K63.5)
Clinical Validation Requirements
- Pathology report confirming adenomatous histology
Code-Specific Risks
- Incorrect use if histology is not adenomatous.
Coding Notes
- Ensure pathology confirms adenomatous nature before coding.
K63.5 - Polyp of colon
Use when the polyp is hyperplastic or histology is unspecified.
Applicable To
- Hyperplastic polyp of colon
Excludes
- Adenomatous polyp (D12.x)
Clinical Validation Requirements
- Clinical documentation indicating hyperplastic nature
Coding Notes
Default code for unspecified polyps unless adenomatous histology is confirmed.
K51.4 - Inflammatory polyps of colon
Use when polyps are associated with inflammatory bowel disease.
Applicable To
- Polyps associated with inflammatory bowel disease
Excludes
- Adenomatous polyp (D12.x)
- Hyperplastic polyp (K63.5)
Clinical Validation Requirements
- Association with inflammatory bowel disease
Coding Notes
Ensure documentation supports IBD association.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Polyp to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D12.0.
Impact
Clinical: May lead to inappropriate surveillance intervals, Regulatory: Non-compliance with coding standards, Financial: Potential for incorrect billing
Mitigation Strategy
Ensure pathology reports are reviewed before final coding, Use templates to capture all necessary details
Impact
Reimbursement: May result in lower reimbursement, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Ensure pathology confirms adenomatous nature and use D12.x
Impact
Lack of histology details can lead to incorrect coding
Mitigation Strategy
Implement dual-pathology review process
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 Polyp, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polyp
Use these documentation templates to ensure complete and accurate documentation for Polyp. These templates include all required elements for proper coding and billing.
Colonoscopy with Polyp Removal
Specialty: GastroenterologyRequired Elements
- Indication for procedure
- Bowel preparation quality
- Polyp location and size
- Histology findings
- Follow-up recommendations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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