Is K60.3 a billable ICD-10-CM code?

No. K60.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does K60.3 sit in the tabular list?

Diseases of the digestive system (K00-K95), in the block Other diseases of intestines (K55-K64).

What cannot be coded together with K60.3?

K60.3 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.

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

Also inherited, and the opposite of Excludes1: these conditions are not part of K60.3, but a patient can have both, so you may code both.

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

These codes carry an Excludes1 note pointing at K60.3. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading K60.3 alone.

K62.6Ulcer of anus and rectum

Risk adjustment

K60.3 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

K60.3 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A59713Billing and Coding: Botulinum Toxin Injections
A59725Billing and Coding: Botulinum Toxins Injections
A59727Billing and Coding: Botulinum Toxin Injections
A59728Billing and Coding: Botulinum Toxin Injections

Code history

What changed, and when. Derived by diffing consecutive CMS release files — which matters when you are defending a code assigned under an earlier edition.

deletedFY2024-FY2026
Anal fistula

Code to one of these instead K60.3

3 child codes. Green means billable.

Related codes at this level

Codes that share K60. If K60.3 is not quite right, the correct code is usually one of these.

Questions about K60.3

Is K60.3 a billable ICD-10-CM code?: No. K60.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does K60.3 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Other diseases of intestines (K55-K64).
What cannot be coded together with K60.3?: K60.3 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.