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K60.42 ICD-10-CM Code: Rectal fistula, complex

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

Tabular directives
4 inclusion terms · 3 Excludes1 · 2 Excludes2 · 3 code-first instructions · 4 code-also instructions

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K60.42 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 K60.42 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Extrasphincteric rectal fistula
  • High intersphincteric rectal fistula
  • Suprasphincteric rectal fistula
  • Transsphincteric rectal fistula

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

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable:
  • perianal abscess (K61.0)
  • rectovaginal fistula (N82.3)
  • stenosis of anus and rectum (K62.4)

Coder workflow for K60.42

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

Before you code K60.42

  1. K60.42 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).

    ReviewK60.421, K60.422, K60.423, K60.429

    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 K60.42. 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 K60.42?
    Yes → Select that code and continue the checks below on its own page.
    No → K60.42 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewK60.421, K60.422, K60.423, K60.429

  2. Does the documentation support a condition named in K60.42’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 K60.42.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewK50, K51

Consider K60.42. Then review the Code Also note, and 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 K60.42(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K60.42: 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 K60.42(2 notes)

    Coding workflow: The conditions named in this note are not included in K60.42. 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 K60.42. Do not add an underlying condition the record does not document.

    ReviewK50, K51

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

  • Code Also — related condition(4 notes)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    ReviewK61.0, N82.3, K62.4

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

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

Documentation: Both the condition K60.42 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, complex is a non-billable ICD-10-CM category code (K60.42). 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. 4 Code Also notes — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  3. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 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 structured relationships — computed from published CMS and AHRQ datasets

Other codes that name K60.42 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.

Related Codes

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

Contextual Map

Every relationship of K60.42 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 K60.42 with these 8 related codes in Claim Check

Hierarchy

Code Also

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

Nearest codes (39)

Change history

Common coding questions

Can K60.42 be billed directly?

No. K60.42 (Rectal fistula, complex) 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 FY2026 tabular list, index and tables, effective October 1, 2025 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
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. "K60.42 — Rectal fistula, complex." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/k60.42-rectal-fistula-complex

Change history

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K60.42 in its code family, with their registry titles.

View all codes in the K60 family