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K60.4 ICD-10-CM Code: Rectal fistula

Compare with another code for K60.4Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Official instructions
1 inclusion term · 3 Excludes1 · 2 Excludes2 · 3 code-first instructions

What these terms mean →

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

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, and is marked with where it comes from.

Code firstSequence the underlying condition before this code
  • Code first, if applicable:
  • Crohn's disease (K50.-)
  • ulcerative colitis (K51.-)
Excludes1Not reported with this code unless documented as unrelated
  • congenital fistula (Q43.6)
  • rectovaginal fistula (N82.3)
  • vesicorectal fistual (N32.1)
Excludes2from K60Not included here; may be reported together
  • abscess or cellulitis of anal and rectal regions (K61.-)
  • anal sphincter tear (healed) (nontraumatic) (old) (K62.81)
IncludesWhat this code covers
  • Fistula of rectum to skin

Where it sits Source: CMS/NCHS

Under:Chapter 11: Diseases of the Digestive SystemK55-K64 Other diseases of intestinesK60 Fissure and fistula of anal and rectal regions

Codes under K60.4 (3)

  • K60.40Rectal fistula, unspecifiedBillable
  • K60.41Rectal fistula, simpleNot billable
  • K60.42Rectal fistula, complexNot billable

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K60.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on K60.4 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Fistula of rectum to skin

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from K60

Code First

Underlying conditions that must be sequenced before this code.

  • Code first, if applicable:
  • Crohn's disease (K50.-)
  • ulcerative colitis (K51.-)

Coder workflow for K60.4

MedCoder structured workflow — derived from this code’s own official record

Before you code K60.4

  1. K60.4 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewK60.40, K60.41, K60.42

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with the code beneath K60.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support one of the more specific codes beneath K60.4?
    Yes → Select that code and continue the checks below on its own page.
    No → K60.4 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewK60.40, K60.41, K60.42

  2. Does the documentation support a condition named in K60.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewQ43.6, N82.3, N32.1

  3. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then the code beneath K60.4.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewK50, K51

Report the code beneath K60.4 that the documentation supports, not K60.4 itself. Then confirm that code is valid for the date of service on its own page.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes1 — check before selecting K60.4(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K60.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareQ43.6, N82.3, N32.1

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of K60.4(2 notes)

    Coding workflow: The conditions named in this note are not included in K60.4. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareK61, K62.81

    See the official tabular notes · Guidelines I.A.12.b

  • Code First — sequencing check(3 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before K60.4. Do not add an underlying condition the record does not document.

    ReviewK50, K51

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition K60.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewQ43.6, N82.3, N32.1

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewK50, K51

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse K60.4 with…

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

The codes most likely to be picked instead of K60.4 — 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.

  • Q43.6— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of congenital fistula moves the case to Q43.6; the two are not reported together unless documented as unrelated.

    Full comparison: K60.4 vs Q43.6 →

  • N82.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of rectovaginal fistula moves the case to N82.3; the two are not reported together unless documented as unrelated.

    Full comparison: K60.4 vs N82.3 →

  • N32.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of vesicorectal fistual moves the case to N32.1; the two are not reported together unless documented as unrelated.

    Full comparison: K60.4 vs N32.1 →

  • K60.2— 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 “Anal fissure, unspecified” takes K60.2; specificity in the record moves it back here.

    Full comparison: K60.4 vs K60.2 →

  • K61— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of abscess or cellulitis of anal and rectal regions adds K61; it is not part of this code and both may be reported when both are documented.

    Full comparison: K60.4 vs K61 →

  • K62.81— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of anal sphincter tear (healed) (nontraumatic) (old) adds K62.81; it is not part of this code and both may be reported when both are documented.

    Full comparison: K60.4 vs K62.81 →

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

Rectal fistula is a non-billable ICD-10-CM category code (K60.4). A more specific billable subcode must be selected for claims submission.

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

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Sequencing: 3 Code First instructions — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 2 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

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 K60.4 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 Excludes1 note: K62.6 — Ulcer of anus and rectum (via K60.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes: K62.81 — Anal sphincter tear (healed) (nontraumatic) (old) (via K60.-), K63.2 — Fistula of intestine (via K60.-).

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

Referenced by 2 Use Additional Code instructions: K50 — Crohn's disease [regional enteritis], K51 — Ulcerative colitis.

These codes instruct coders to additionally report this code when it applies.

Clinical classification (AHRQ CCSR):DIG015 — Anal and rectal 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 (Anal and rectal conditions).

K60.3 — Anal fistula, K60.30 — Anal fistula, unspecified, K60.311 — Anal fistula, simple, initial, K60.312 — Anal fistula, simple, persistent, K60.313 — Anal fistula, simple, recurrent, K60.319 — Anal fistula, simple, unspecified, K60.321 — Anal fistula, complex, initial, K60.322 — Anal fistula, complex, persistent, K60.323 — Anal fistula, complex, recurrent, K60.329 — Anal fistula, complex, unspecified, K60.40 — Rectal fistula, unspecified, K60.411 — Rectal fistula, simple, initial, K60.412 — Rectal fistula, simple, persistent, K60.413 — Rectal fistula, simple, recurrent, K60.419 — Rectal fistula, simple, unspecified, K60.421 — Rectal fistula, complex, initial, K60.422 — Rectal fistula, complex, persistent, K60.423 — Rectal fistula, complex, recurrent, K60.429 — Rectal fistula, complex, unspecified, K60.5 — Anorectal fistula, +38 more

Contextual Map

Every relationship of K60.4 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 K60.4 with these 8 related codes in Claim Check

Hierarchy

Excludes1

Code First

Referenced by Excludes1 notes

  • K62.6 — Ulcer of anus and rectum[Excludes1](via K60.-): “fissure and fistula of anus and rectum (K60.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Excludes2 notes

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

Nearest codes (39)

Change history (2)

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.

Common coding questions

MedCoder editorial

Can K60.4 be billed directly?

No. K60.4 (Rectal fistula) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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 28, 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. "K60.4 — Rectal fistula." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/k60.4-rectal-fistula

Change history

  • FY2025 — October 1, 2024
    Became a non-billable header
    FY2025 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Rectal fistula

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K60.4 in its code family, with their registry titles.

View all codes in the K60 family