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.
Check K63.1 with the rest of the claim: free scrubberExcludes1: 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
Their own Excludes1 notes name this code, so the conflict is not listed above.
- 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
K63.1 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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
Alphabetic index entries that lead here
- 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)
Code history
Unchanged in every release from FY2024 to FY2027.