ICD-10 K63.2
Billable / Specific CCFistula of intestine
About ICD-10-CM K63.2
ICD-10-CM code K63.2 represents Fistula of intestine. This is a billable/specific code in the Digestive System chapter (block K63). The 2026 edition of ICD-10-CM K63.2 became effective on October 1, 2025.
Coding Tips for K63.2
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K63.2 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with K63.2. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- fistula of duodenum (K31.6)
- fistula of intestine with Crohn's disease (K50.013, K50.113, K50.813, K50.913,)
- fistula of intestine with ulcerative colitis (K51.013, K51.213, K51.313, K51.413, K51.513, K51.813, K51.913)
Type 2 Excludes
Not included here, the excluded code is not part of K63.2, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- fistula of anal and rectal regions (K60.-)
- fistula of appendix (K38.3)
- intestinal-genital fistula, female (N82.2-N82.4)
- vesicointestinal fistula (N32.1)
Coding Notes
Code Also
- , if applicable, disruption of internal operation (surgical) wound (T81.32-)
Inpatient DRG Impact, CC
code Fistula of intestine. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K63.2
Local Coverage Determinations (LCDs) from CMS MACs that list K63.2 as a covered diagnosis.
Showing top 10 of 231 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K63.2.
5 Medicare
3 Aetna
CPT Codes Commonly Billed with K63.2
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert K63.2 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| K63.2 | 56981 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K63.2
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K63.2, Billing FAQ
Is ICD-10 code K63.2 billable? +
Yes, K63.2 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for K63.2? +
Type 1 Excludes (never code together with K63.2): fistula of duodenum (K31.6); fistula of intestine with Crohn's disease (K50.013, K50.113, K50.813, K50.913,); fistula of intestine with ulcerative colitis (K51.013, K51.213, K51.313, K51.413, K51.513, K51.813, K51.913)
What codes are Type 2 Excludes for K63.2? +
Type 2 Excludes (may be coded together when both conditions exist): fistula of anal and rectal regions (K60.-); fistula of appendix (K38.3); intestinal-genital fistula, female (N82.2-N82.4)
Is K63.2 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does K63.2 map to? +
Per CMS GEMs, K63.2 maps to ICD-9 codes: 56981. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team