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ICD-10 Coding for Proctitis(K62.7, K51.20, A54.6)

Complete ICD-10-CM coding and documentation guide for Proctitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Rectal InflammationInflammation of the Rectum

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Related ICD-10 Code Ranges

Complete code families applicable to Proctitis

K62-K63Primary Range

Other diseases of the intestine

This range includes codes for various forms of proctitis, including radiation and ulcerative types.

A54

Gonococcal infection

Includes codes for gonococcal proctitis, which is an infectious cause of the condition.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
K62.7Radiation proctitisUse when proctitis is directly linked to prior radiation therapy.
  • History of pelvic radiation
  • Endoscopic findings of telangiectasia or ulceration
K51.20Ulcerative proctitis without complicationsUse for ulcerative proctitis confirmed by endoscopy without complications.
  • Endoscopic confirmation of ulcerative changes
  • Symptoms of rectal bleeding or pain
A54.6Gonococcal proctitisUse when proctitis is confirmed to be caused by gonorrhea.
  • Positive NAAT for Neisseria gonorrhoeae
  • Symptoms of rectal discharge or pain

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 radiation proctitis

Essential facts and insights about Proctitis

The ICD-10 code for radiation proctitis is K62.7.

Primary ICD-10-CM Codes for proctitis

K62.7
Radiation proctitis
Billable Code

Decision Criteria

clinical Criteria

  • Patient has a history of radiation therapy.

Applicable To

  • Proctitis due to radiation therapy

Excludes

Clinical Validation Requirements

  • History of pelvic radiation
  • Endoscopic findings of telangiectasia or ulceration

Code-Specific Risks

  • Incorrectly coding without confirming radiation history

Coding Notes

  • Ensure radiation history is documented.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Rectal bleeding

R19.5
Use to document associated rectal bleeding.

Pelvic and perineal pain

R10.2
Use to document associated pelvic pain.

HIV disease

B20
Use if the patient is also diagnosed with HIV.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Ulcerative proctitis without complications

K51.20
Ulcerative proctitis is related to inflammatory bowel disease, not radiation.

Radiation proctitis

K62.7
Radiation proctitis is linked to prior radiation exposure.

Other specified diseases of anus and rectum

K62.89
Use when etiology is not specified as gonococcal.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Proctitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K62.7.

Impact

Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.

Mitigation Strategy

Always document the cause of proctitis if known., Use specific codes when etiology is confirmed.

Impact

Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health data.

Mitigation Strategy

Always use the most specific code available based on documentation.

Impact

Use of unspecified codes when specific codes are available.

Mitigation Strategy

Regular training on specific coding requirements and updates.

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 Proctitis, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Proctitis

Use these documentation templates to ensure complete and accurate documentation for Proctitis. These templates include all required elements for proper coding and billing.

Ulcerative proctitis with bleeding

Specialty: Gastroenterology

Required Elements

  • Symptoms
  • Endoscopic findings
  • Treatment plan

Example Documentation

Assessment: Ulcerative proctitis with rectal bleeding confirmed by sigmoidoscopy. Plan: Start mesalamine suppositories.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Proctitis noted.
Good Documentation Example
Ulcerative proctitis with rectal bleeding, confirmed by sigmoidoscopy; no fistulae/abscess.
Explanation
The good example provides specific findings and confirms the diagnosis with endoscopy.

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