K60.42 vs N82.3

K60.42 (Rectal fistula, complex) compared with N82.3 (Fistula of vagina to large intestine), from the official CMS tabular data.

Summary

These codes should not be reported together because K60.42’s tabular entry lists N82.3 under Excludes1.

Official rule

What is different?

The conditions named, billing status and chapter.K60.42 is “Rectal fistula, complex”; N82.3 is “Fistula of vagina to large intestine”. K60.42 is a non-billable header; N82.3 is billable. K60.42 sits in K00-K95 — Diseases of the Digestive System (K00-K95); N82.3 in N00-N99 — Diseases of the Genitourinary System (N00-N99).

Registry fact

Can these codes be reported together?

No.K60.42’s entry carries an Excludes1 note covering N82.3: “rectovaginal fistula (N82.3)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.K60.42’s tabular entry: “rectovaginal fistula (N82.3)”. The note covers N82.3.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. K60.42 carries 2 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.K60.42 is a non-billable header, but N82.3 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

No order is given.The Code Also note linking them states no sequencing order; sequence by the reason for the encounter.

Official ruleGuide: Code First vs Use Additional Code vs Code Also

Are there other coding relationships?

Yes.Both codes may be needed together. K60.42 carries a Code Also note covering N82.3: “rectovaginal fistula (N82.3)”

Official ruleGuide: Code First vs Use Additional Code vs Code Also

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Code Also relationship

K60.42

Rectal fistula, complex

↔

N82.3

Fistula of vagina to large intestine

What we found

Both codes may be needed together.K60.42 carries a Code Also note covering N82.3: “rectovaginal fistula (N82.3)”

A Code Also note means the two codes may both be required to fully describe the condition. CMS states no sequencing order for it — sequence by the reason for the encounter.

What to review

Report both when both are needed to describe the condition, sequenced by the reason for the encounter.

Guide: Code First vs Use Additional Code vs Code Also Check these on a claim

Why it matters

A "Code Also" note means two codes may be required together, but the Guidelines state no sequencing order for it -- sequence by the reason for the encounter, not by this relationship.

Source / rule

CMS ICD-10-CM tabular instructional notes

Excludes1 — generally not reported together

Excludes1 conflict

K60.42

Rectal fistula, complex

↔

N82.3

Fistula of vagina to large intestine

What we found

No — do not report together.K60.42 carries an Excludes1 note covering N82.3: “rectovaginal fistula (N82.3)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2 Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

Section I.A.12.a — Excludes1 · applies to: Excludes1
A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.
ICD-10-CM Official Guidelines FY2026
Section I.A.17 — “Code also ” note · applies to: Code also
A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.
ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

	K60.42Rectal fistula, complex	N82.3Fistula of vagina to large intestine
Billing status	Non-billable header Report instead: K60.421, K60.422, K60.423, K60.429	Billable
Classification	K00-K95 — Diseases of the Digestive System (K00-K95)	N00-N99 — Diseases of the Genitourinary System (N00-N99)
Definition	Rectal fistula, complex is a non-billable ICD-10-CM category code (K60.42).	Fistula of vagina to large intestine is a billable ICD-10-CM diagnosis code (N82.3).
Includes	Extrasphincteric rectal fistula High intersphincteric rectal fistula Suprasphincteric rectal fistula Transsphincteric rectal fistula	Rectovaginal fistula
Excludes1	congenital fistula (Q43.6) rectovaginal fistula (N82.3) vesicorectal fistual (N32.1)	vesicointestinal fistulae (N32.1)
Excludes2	abscess or cellulitis of anal and rectal regions (K61.-) anal sphincter tear (healed) (nontraumatic) (old) (K62.81)	—
Code first	, if applicable: Crohn's disease (K50.-)	—
Code also	, if applicable: perianal abscess (K61.0) rectovaginal fistula (N82.3) stenosis of anus and rectum (K62.4)	—

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources