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Excludes 1 Note for K63.5

Robyn Posted Tue 13th of October, 2015 15:45:33 PM

It is my understanding that K63.5 Polyp of colon, is to be used for hyperplastic colon polyps. The excludes 1 note for K63.5 has listed D12.6 adenomatous polyp of colon & K51.4- inflammatory polyp of colon. My question is when several polyps are removed and some are adenomas & some are hyperplastic does this mean I should not use both the D12- codes & K63.5 on the claim because of the excludes 1 note? Thank you.

SuperCoder Answered Wed 14th of October, 2015 05:33:39 AM

Well, as per the guidelines when you code K63.5, Excludes 1 can not be coded with the code. K63.5 is not clear that which type of polyp it is, it is just mentioned "polyp of colon". So, when type of polyp is clear (like adenomatous or hyperplastic) then code for that specific form of polys ICDs. Then need not to bill K63.5 in that scenario. Hope it helps!

Robyn Posted Wed 14th of October, 2015 12:46:37 PM

Well, there is no specific code for hyperplastic polyps, so I would think you would default to K63.5 for a hyperplastic polyp. You can't code it as a neoplasm using the D codes because hyperplastic polyps are non-neoplastic & the D codes specifically state "neoplasm". Also, it is not an iflammatory polyp, so the K51.4- codes are not applicable for hyperplastic polyps. So I guess I have a different question now: What code do you recommend for hyperplastic colon polyps?

SuperCoder Answered Thu 15th of October, 2015 04:31:10 AM

Absolutely correct. These were some of the examples given to you. When it is not mentioned about the type of the specific condition, then always use the other specified codes. But, in ICD-10- polyp of colon is given without the specificity of the type, so for hyperplastic colon polys ICD-10 K63.5 can be used.

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