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K60.411 ICD-10-CM Code: Rectal fistula, simple, initial

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

Coding at a Glance

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

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 v43, 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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K60.411 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on K60.411 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Rectal, fistula, simple, new

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).

Source: inherited from K60.4

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.-)

Source: inherited from K60.4

Coder workflow for K60.411

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

Before you code K60.411

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with K60.411. 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 a condition named in K60.411’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

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then K60.411.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewK50, K51

Consider K60.411. Then confirm the code is valid for the date of service in the Verify section.

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).
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 K60.411(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K60.411: 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 K60.411(2 notes)

    Coding workflow: The conditions named in this note are not included in K60.411. 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 K60.411. 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 K60.411 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.

Code Overview

Rectal fistula, simple, initial is a billable ICD-10-CM diagnosis code (K60.411).

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

Indexed Clinical Terms (2)

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.

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

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

  • 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 structured relationships — computed from published CMS and AHRQ datasets

Other codes that name K60.411 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] (via K60.4.-), K51 — Ulcerative colitis (via K60.4.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 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):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).

K60.311 — 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, K60.4 — Rectal fistula, K60.40 — Rectal fistula, unspecified, 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, K60.50 — Anorectal fistula, unspecified, K60.511 — Anorectal fistula, simple, initial, +38 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.

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 (gastric), K38.3 — Fistula of appendix (appendix, appendicular), K61.39 — Other ischiorectal abscess (ischiorectal), K63.2 — Fistula of intestine (colon), K65.9 — Peritonitis, unspecified (peritoneum), K82.3 — Fistula of gallbladder (cholocolic), K83.3 — Fistula of bile duct (bile duct), K86.89 — Other specified diseases of pancreas (pancreatic), K94.09 — Other complications of colostomy (colostomy), L98.8 — Other specified disorders of the skin and subcutaneous tissue, M25.10 — Fistula, unspecified joint (joint), M25.11 — Fistula, shoulder (joint, shoulder), +82 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Fecal Occult Blood Test (FOBT)

Contextual Map

Every relationship of K60.411 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 K60.411 with these 5 related codes in Claim Check

Hierarchy

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-fy2026

Referenced by Excludes2 notes

Referenced by Use Additional Code instructions

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. 5,744 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Fistula (cutaneous), rectal (infectional), simple, initial[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Fistula (cutaneous), rectal (infectional), simple, new[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (39)

Change history

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 FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 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 — v43 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 structured 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 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.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

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. "K60.411 — Rectal fistula, simple, initial." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/k60.411-rectal-fistula-simple-initial

Change history

  • FY2025 — October 1, 2024
    Added to the code set
    Rectal fistula, simple, initial
    FY2025 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K60.411 in its code family, with their registry titles.

View all codes in the K60 family