Is K60.40 a billable ICD-10-CM code?

Yes. K60.40 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does K60.40 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 K60.40?

K60.40 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above K60.40 (K60.4) and apply to it just the same.

K60.40

K60.40 — Rectal fistula, unspecified

Billable / specific codeICD-10-CM

K60.40 is a billable, specific ICD-10-CM code for rectal fistula, unspecified. It is valid for submission on a claim.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Rectal fistula NOS

Excludes1 inherited from the categories above K60.40

These are not written on K60.40, but they bind it: a note on a category applies to every code beneath it. Billing K60.40 with anything listed here is a denial.

Written on K60.4 — Rectal fistula

congenital fistula (Q43.6)
rectovaginal fistula (N82.3)
vesicorectal fistual (N32.1)

Excludes2 inherited from the categories above K60.40

Also inherited, and the opposite of Excludes1: these conditions are not part of K60.40, 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 K60.40

These codes carry an Excludes1 note pointing at K60.40. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading K60.40 alone.

K62.6Ulcer of anus and rectum

Risk adjustment

K60.40 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

K60.40 is named in 8 Medicare coverage policies — 8 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56632Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
A57185Billing and Coding: Botulinum Toxin Injections
A57186Billing and Coding: Botulinum Toxin Injections
A59707Billing and Coding: Botulinum Toxin Injections

How K60.40 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to K60.40.

Fistula›perineorectal
Fistula›perirectal
Fistula›rectal(infectional)
Fistula›rectum(to skin)

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.

addedFY2024-FY2026
Rectal fistula, unspecified

Related codes at this level

Codes that share K60.4. If K60.40 is not quite right, the correct code is usually one of these.

Questions about K60.40

Is K60.40 a billable ICD-10-CM code?: Yes. K60.40 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does K60.40 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 K60.40?: K60.40 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above K60.40 (K60.4) and apply to it just the same.