K60.3

K60.3: Anal fistula

Non-billable headerICD-10-CM

K60.3 is a non-billable header ICD-10-CM code for anal fistula. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital fistula (Q43.6)

Code first

The underlying condition must be sequenced before this code.

, if applicable:
Crohn's disease (K50.-)
ulcerative colitis (K51.-)

Excludes2 inherited from the categories above K60.3

Not part of this code, but both may be coded when both are present.

Written on K60: Fissure and fistula of anal and rectal regions

abscess or cellulitis of anal and rectal regions (K61.-)
anal sphincter tear (healed) (nontraumatic) (old) (K62.81)

Other codes that can never be billed with K60.3

Their own Excludes1 notes name this code, so the conflict is not listed above.

K62.6Ulcer of anus and rectum

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

K60.3 is named in 4 Medicare coverage policies: 4 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A59725Billing and Coding: Botulinum Toxins Injections
A59727Billing and Coding: Botulinum Toxin Injections
A59728Billing and Coding: Botulinum Toxin Injections
A59808Billing and Coding: Botulinum Toxin Injections

Code history

deletedFY2024-FY2027
Anal fistula

Code to one of these instead K60.3

3 child codes. Green means billable.