K60.42
K60.42: Rectal fistula, complex
Non-billable headerICD-10-CM
K60.42 is a non-billable header ICD-10-CM code for rectal fistula, complex. It cannot be billed on its own: choose one of the more specific child codes below.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Extrasphincteric rectal fistula
- High intersphincteric rectal fistula
- Suprasphincteric rectal fistula
- Transsphincteric rectal fistula
Excludes1 inherited from the categories above K60.42
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above K60.42
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with K60.42
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.
Code history
Unchanged in every release from FY2024 to FY2027.
Code to one of these instead K60.42
4 child codes. Green means billable.