K63.1 — Perforation of intestine (nontraumatic)
K63.1 is a billable, specific ICD-10-CM code for perforation of intestine (nontraumatic). It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Perforation (nontraumatic) of rectum
Other codes that can never be billed with K63.1
These codes carry an Excludes1 note pointing at K63.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading K63.1 alone.
- K63.3Ulcer of intestine
Risk adjustment
K63.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 78 Intestinal Obstruction/Perforation0.326 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
K63.1 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.
- A56394Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
- A56632Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
How K63.1 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 K63.1.
- Perforation, perforated›bowel
- Perforation, perforated›colon
- Perforation, perforated›ileum
- Perforation, perforated›intestine NEC
- Perforation, perforated›jejunum, jejunal
- Perforation, perforated›rectum
- Perforation, perforated›sigmoid
- Rupture, ruptured›bowel(nontraumatic)
- Rupture, ruptured›colon(nontraumatic)
- Rupture, ruptured›intestine NEC(nontraumatic)
- Rupture, ruptured›rectum(nontraumatic)
- Rupture, ruptured›sigmoid(nontraumatic)
Related codes at this level
Codes that share K63. If K63.1 is not quite right, the correct code is usually one of these.
Questions about K63.1
- Is K63.1 a billable ICD-10-CM code?
- Yes. K63.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does K63.1 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 K63.1?
- K63.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.