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K38.3 ICD-10-CM Code: Fistula of appendix

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Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

The tabular list publishes no instructional note for this code itself.

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Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 393 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC (MDC 06)
  • MS-DRG 394 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC (MDC 06)
  • MS-DRG 395 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC (MDC 06)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Don’t confuse K38.3 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of K38.3 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • K38.9— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Disease of appendix, unspecified” takes K38.9; specificity in the record moves it back here.

    Full comparison: K38.3 vs K38.9 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Fistula of appendix is a billable ICD-10-CM diagnosis code (K38.3).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 11: Diseases of the Digestive System (K00-K95)

Reserved for future guideline expansion

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name K38.3 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: K63.2 — Fistula of intestine.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 3 MS-DRGs: DRG 393 (MDC 06), DRG 394 (MDC 06), DRG 395 (MDC 06).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):DIG009 — Appendicitis and other appendiceal conditions (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Appendicitis and other appendiceal conditions).

K35.21 — Acute appendicitis with generalized peritonitis, with abscess, K35.210 — Acute appendicitis with generalized peritonitis, without perforation, with abscess, K35.211 — Acute appendicitis with generalized peritonitis, with perforation and abscess, K35.219 — Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation, K35.3 — Acute appendicitis with localized peritonitis, K35.30 — Acute appendicitis with localized peritonitis, without perforation or gangrene, K35.31 — Acute appendicitis with localized peritonitis and gangrene, without perforation, K35.32 — Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess, K35.33 — Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess, K35.80 — Unspecified acute appendicitis, K35.89 — Other acute appendicitis, K35.890 — Other acute appendicitis without perforation or gangrene, K35.891 — Other acute appendicitis without perforation, with gangrene, K36 — Other appendicitis, K37 — Unspecified appendicitis, K38.0 — Hyperplasia of appendix, K38.1 — Appendicular concretions, K38.2 — Diverticulum of appendix, K38.8 — Other specified diseases of appendix, K38.9 — Disease of appendix, unspecified, +5 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Fistula”; these codes share that main term but sit in a different category of the Tabular List.

J38.7 — Other diseases of larynx (larynx), J39.2 — Other diseases of pharynx (pharynx), J86.0 — Pyothorax with fistula (lung), J95.04 — Tracheo-esophageal fistula following tracheostomy (tracheoesophageal, following tracheostomy), K04.6 — Periapical abscess with sinus (dental), K11.4 — Fistula of salivary gland (parotid), K12.2 — Cellulitis and abscess of mouth (oral), K13.0 — Diseases of lips (lip), K22.89 — Other specified disease of esophagus (esophagus), K31.6 — Fistula of stomach and duodenum (stomach), K60.30 — Anal fistula, unspecified (in ano), K60.31 — Anal fistula, simple (anus, anal, superficial), K60.311 — Anal fistula, simple, initial (anus, anal, simple, new), K60.312 — Anal fistula, simple, persistent (anus, anal, simple, chronic), K60.313 — Anal fistula, simple, recurrent (anus, anal, simple, recurrent), K60.319 — Anal fistula, simple, unspecified (anus, anal, simple), K60.32 — Anal fistula, complex (anus, anal, suprasphincteric), K60.321 — Anal fistula, complex, initial (anus, anal, complex, new), K60.322 — Anal fistula, complex, persistent (anus, anal, complex, chronic), K60.323 — Anal fistula, complex, recurrent (anus, anal, complex, recurrent), +114 more

Contextual Map

Every relationship of K38.3 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run K38.3 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 06 — Diseases and Disorders of the Digestive System[MDC crossing]: “Diseases and Disorders of the Digestive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,748 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Fistula (cutaneous), appendix, appendicular[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "K38.3 — Fistula of appendix." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/k38.3-fistula-of-appendix

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Fistula of appendix

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K38.3 in its code family, with their registry titles.

View all codes in the K38 family