Wiki etiology/manifestation coding convention

[lindam@caricures.com]

Does anyone know where I can find information on etiology/manifestation coding convention. I have a claim that is denying as diagnosis submitted cannot be the first listed diagnosis according to etiology/manifestation coding convention.

Dx K60.311 Anal fistula, simple, initial. Procedure 46270 Fistulectomy, subcutaneous.

I don't think the denial is correct, but I am looking for corroborating information to support my appeal

 

[sls314]

Does anyone know where I can find information on etiology/manifestation coding convention. I have a claim that is denying as diagnosis submitted cannot be the first listed diagnosis according to etiology/manifestation coding convention.

Dx K60.311 Anal fistula, simple, initial. Procedure 46270 Fistulectomy, subcutaneous.

I don't think the denial is correct, but I am looking for corroborating information to support my appeal

The K60.3- category has a Code First, if applicable note for Crohn's Disease (K50.-) and Ulcerative Colitis (K51.-).

Does the patient have either of those conditions? If so, it should be coded and sequenced first, followed by the K60.311.

 

[lindam@caricures.com]

What if they don't have either of those conditions? Where do I find this information so I can look at it too. THank you

 

[sls314]

What if they don't have either of those conditions? Where do I find this information so I can look at it too. THank you

The Code First note can be found in the ICD-10-CM book (or an online encoder such as EncoderPro or Codify if you're using that instead of a physical book.) When you look up category K60.3-, you'll see the Code First instruction listed at the beginning of the category for all codes in that range.

The etiology/manifestation convention is outlined in the ICD-10-CM Official Guidelines for Coding and Reporting. These guidelines are located at the front of the ICD-10-CM manual, and a PDF version of the guidelines is also available on the CMS website: https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf

 

[lindam@caricures.com]

Thank you for this information. I'm still not sure how to code it if the patient doesn't have Crohn's or Ulcerative colitis. They just have a fistula.