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
Risk adjustment
K60.42 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.
Code to one of these instead K60.42
4 child codes. Green means billable.
Related codes at this level
Codes that share K60.4. If K60.42 is not quite right, the correct code is usually one of these.
Questions about K60.42
- Is K60.42 a billable ICD-10-CM code?
- No. K60.42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does K60.42 sit in the tabular list?
- Diseases of the digestive system (K00-K95), in the block Other diseases of intestines (K55-K64).