K51.20 ICD-10-CM Code: Ulcerative (chronic) proctitis without complications
K51.20 maps to CMS-HCC V28 81. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Noninfective enteritis and colitis (K50-K52)
K51.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUlcerative (chronic) proctitis without complications
A chronic inflammatory condition limited to the rectum (the lowest part of the colon) without any complications. This is the simplest form of ulcerative proctitis.
Buddy Insight
Ulcerative proctitis without complications is the mildest and most limited form of ulcerative colitis, confined to the rectum.
CMS-HCC V28
MappedHCC 81
Coefficient HCC 81: 0.244 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 048
Code-level coefficient reference
ESRD/PACE
MappedHCC 35
Code-level coefficient reference
RXHCC
MappedHCC 67
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Ulcerative (chronic) proctitis NOS
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from K00-K95
- certain infectious and parasitic diseases (A00-B99)Inherited from K00-K95
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from K00-K95
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from K00-K95
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from K00-K95
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from K00-K95
- neoplasms (C00-D49)Inherited from K00-K95
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from K00-K95
Related Codes
Includes
Official- noninfective inflammatory bowel diseaseInherited from K50-K52
Excludes 1
Official- irritable bowel syndrome (K58.-)Inherited from K50-K52, K51
- megacolon (K59.3-)Inherited from K50-K52, K51
- Crohn's disease [regional enteritis] (K50.-)Inherited from K50-K52, K51
Code First
OfficialNo Code First sequencing instructions are included in this display for K51.20. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any associated fistulas, if applicable:Inherited from K51
- anal fistula (K60.3-)Inherited from K51
- anorectal fistula (K60.5-)Inherited from K51
- rectal fistula (K60.4-)Inherited from K51
- code to identify manifestations, such as:Inherited from K51
- pyoderma gangrenosum (L88)Inherited from K51
Code Also
OfficialNo Code Also instructions are included in this display for K51.20. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is K51.20 an HCC code?
Yes. K51.20 (Ulcerative (chronic) proctitis without complications) maps to HCC 81, Ulcerative Colitis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.244. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: K51.20 is billable and maps to V28 HCC 81, Ulcerative Colitis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- K51.20
- Description
- Ulcerative (chronic) proctitis without complications
- HCC (V28)
- HCC 81 — Ulcerative Colitis
- RAF reference coefficient
- 0.244
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work K51.20 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for K51.20
For K51.20, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
K51.20 is the ICD-10-CM diagnosis code for ulcerative (chronic) proctitis without complications. A chronic inflammatory condition limited to the rectum (the lowest part of the colon) without any complications. This is the simplest form of ulcerative proctitis. K51.20 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering noninfective enteritis and colitis (k50-k52).
Under the CMS-HCC V28 risk adjustment model, K51.20 maps to Ulcerative Colitis (HCC 81) with a source-labeled community, non-dual, aged reference coefficient of 0.244. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Confirm that inflammation is limited to the rectum only; if it extends higher, use a different code. For K51.20, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for K51.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm that inflammation is limited to the rectum only; if it extends higher, use a different code
- •Verify no complications are present; if any complications exist, use K51.21x codes instead
Clinical Significance
Ulcerative proctitis without complications is the mildest and most limited form of ulcerative colitis, confined to the rectum. Despite its limited extent, it still represents a chronic inflammatory condition requiring ongoing monitoring, as approximately 10-30% of patients may progress to more extensive disease over time.
Documentation Requirements
- ✓Confirmed diagnosis of ulcerative colitis limited to the rectum via colonoscopy
- ✓Biopsy results consistent with ulcerative colitis histology
- ✓Documentation that inflammation does not extend beyond the rectosigmoid junction
- ✓Statement confirming absence of complications (no bleeding, obstruction, fistula, or abscess)
- ✓Current treatment plan (typically topical aminosalicylates such as mesalamine suppositories)
- ✓Disease activity assessment and surveillance plan
Commonly Confused Codes
- •K51.20 vs K62.89: K62.89 is other specified diseases of rectum; ulcerative proctitis is specifically inflammatory bowel disease
- •K51.20 vs K51.00: K51.00 is pancolitis (entire colon); proctitis is limited to the rectum only
- •K51.20 vs K51.30: K51.30 is rectosigmoiditis (rectum and sigmoid); proctitis is rectum only
- •K51.20 vs K62.7: K62.7 is radiation proctitis; ensure the etiology is ulcerative colitis, not radiation