Hematochezia, or the presence of fresh, bright red blood in the stool, can be a concerning symptom for both patients and healthcare providers. Accurately documenting and coding hematochezia is crucial for correct diagnosis, treatment, and reimbursement.
However, as hematochezia doesn’t have a specific ICD-10 code, understanding which codes to use and when to apply them is essential for proper clinical and administrative processes.
In this article, we will walk through the most commonly used ICD-10 codes for hematochezia, offering tips on accurate documentation, coding guidelines, and practical examples that will help you navigate this important part of your practice.
What Is Hematochezia?
Hematochezia is the clinical term for bright red blood passed rectally, either mixed with or coating the stool. This symptom typically indicates lower gastrointestinal (GI) bleeding, although rapid upper GI bleeding can also occasionally cause it. Common causes include:
- Hemorrhoids
- Anal fissures
- Diverticulosis
- Colorectal polyps or malignancy
- Inflammatory bowel disease (IBD)
- Rectal ulcers
Correct diagnosis depends on identifying the source and severity of the bleeding, making documentation, and proper code selection critical for both care and compliance.
Does Hematochezia Have a Specific ICD-10 Code?
No, hematochezia does not have a dedicated ICD-10-CM code. Instead, providers must select from a group of codes that best represent:
- The underlying cause of the bleeding, or
- The anatomical site involved, or
- The presence of nonspecific gastrointestinal hemorrhage
The key is ensuring that the most accurate and specific code is selected based on available clinical information and documentation.
ICD-10 Codes Commonly Used for Hematochezia
Here are the ICD-10 codes most frequently used in clinical practice to document hematochezia, depending on the identified source:
| ICD-10 Code | Description | When to Use |
| K62.5 | Hemorrhage of anus and rectum | When bleeding is confirmed to originate in the anorectal region. |
| K92.1 | Melena | For black, tarry stools from upper GI bleeding; occasionally used if bleeding is rapid but presents as red. |
| K54.1 | Neonatal melena | Specifically for melena occurring in newborns. |
| K92.2 | Gastrointestinal hemorrhage, unspecified | When GI bleeding is confirmed but the precise site is not yet identified. |
| R19.5 | Other fecal abnormalities | Only when no specific diagnosis or source has yet been found for visible blood. |
These codes are selected based on clinical findings, location, and patient population. Correct usage improves diagnostic accuracy and ensures proper billing.
ICD-10-CM K62.5 – Hemorrhage of Anus and Rectum
- Code: K62.5
- Description: Hemorrhage of anus and rectum
- ICD-10-CM Update: This code became effective on October 1, 2024.
When to Use K62.5
Use K62.5 when the provider confirms that the source of hematochezia is the anus or rectum. This includes bleeding from:
- Hemorrhoids (without prolapse or thrombosis)
- Anal fissures (if not separately coded)
- Rectal ulcers or trauma
Coding Considerations
- Includes: Rectal bleeding with identified anorectal source
- Excludes1:
- Gastrointestinal bleeding NOS (→ K92.2)
- Melena (→ K92.1)
- Neonatal rectal hemorrhage (→ P54.2)
This is the most appropriate and specific code for common cases of hematochezia seen in urgent care, primary care, or emergency settings when the anorectal origin is confirmed.
Additional Codes That May Apply
If the source of bleeding is outside the anus/rectum or uncertain, consider the following ICD-10 options:
K92.1 – Melena
- Use when the stool is dark and tarry due to upper GI bleeding.
- Rarely, hematochezia may result from a massive upper GI bleed if it transits quickly.
- Document clinical justification if using this code in hematochezia cases.
K92.2 – Gastrointestinal Hemorrhage, Unspecified
- Appropriate when GI bleeding is confirmed but the source is not yet localized.
- Common during initial assessment or while awaiting diagnostic imaging or endoscopy.
K54.1 – Neonatal Melena
- Reserved for newborns.
- Should not be used in adult or pediatric cases outside the neonatal period.
R19.5 – Other Fecal Abnormalities
- Use only when no source or specific condition is yet identified.
- This code is not valid as a principal diagnosis and must be paired with additional clinical findings.
Coding Tips and Clinical Documentation Guidance
Accurate coding for hematochezia relies heavily on clear, detailed documentation. Here are key tips for ensuring that clinical notes support the appropriate ICD-10 codes:
Be Specific About the Source: If bleeding is clearly from the anus or rectum, document findings such as hemorrhoids, anal fissures, or rectal ulcers to justify K62.5. If the source is uncertain or under investigation, note that diagnostic work is ongoing and consider K92.2 in the interim.
Include Associated Symptoms: Document any pain, stool consistency, and associated GI symptoms such as nausea, vomiting, or cramping. These clues can help support or rule out upper vs. lower GI origins.
Use the Excludes Notes Wisely: K62.5 excludes melena and GI hemorrhage NOS. If clinical findings change, be ready to update the code to K92.1 or K92.2 as needed.
Avoid R19.5 as a Primary Diagnosis: Use R19.5 only when hematochezia is present but not yet diagnosed, and always pair it with another, more definitive code once available.
Common Coding Scenarios & Examples
Here are a few practical, real-world examples that show how to apply ICD-10 codes for hematochezia in different clinical contexts:
Scenario 1: Hematochezia from Internal Hemorrhoids
Patient presents with bright red rectal bleeding. Exam confirms internal hemorrhoids.
ICD-10 Codes:
- K64.8 (Other hemorrhoids)
- K62.5 (Hemorrhage of anus and rectum)
Use both codes to capture the condition and its complications.
Scenario 2: Fresh Blood with Uncertain Source
Patient reports fresh blood in stool. No clear anorectal findings. Awaiting colonoscopy.
ICD-10 Code:
- K92.2 (Gastrointestinal hemorrhage, unspecified)
Update the code when the bleeding source is identified.
Scenario 3: Hematochezia in a Newborn
Neonate passes blackish-red stool. Upper GI source suspected.
ICD-10 Code:
- K54.1 (Neonatal melena)
Reserved for infants—do not use in older pediatric or adult patients.
Scenario 4: Fresh Blood With No Diagnosis Yet
Bright red blood noted on toilet paper. No rectal exam done.
ICD-10 Code:
- R19.5 (Other fecal abnormalities)
Use only temporarily; not a valid standalone primary diagnosis.
When to Use Unspecified Codes
Use K92.2 – GI Hemorrhage, Unspecified when:
- Bleeding is confirmed but origin is still under evaluation.
- Diagnostic tests like colonoscopy, endoscopy, or imaging are pending.
Avoid Overuse:
- Frequent or chronic use of unspecified codes can flag audits.
- Always update once the source is confirmed.
Use R19.5 – Other Fecal Abnormalities when:
- Blood is noted, but no cause is yet found.
- Use only as a secondary or provisional code, never as a principal diagnosis in claims.
Related Conditions and Differential Diagnoses
When evaluating a patient with hematochezia, consider and document any related or alternative conditions that may be contributing:
- Hemorrhoids (K64.-)
- Anal fissure (K60.2)
- Diverticulosis (K57.-)
- Colorectal cancer (C18–C21)
- Ulcerative colitis (K51.-)
- Crohn’s disease (K50.-)
- Rectal ulcers or trauma (K62.6)
If one of these conditions is diagnosed, be sure to use the specific ICD-10 code associated with it in addition to or instead of the general bleeding code.
Closing Note
Although hematochezia lacks a dedicated ICD-10 code, clinical accuracy doesn’t have to suffer. With the right combination of clinical insight, detailed documentation, and strategic coding, providers can ensure proper care delivery and reimbursement.
Whether you’re treating a patient in a primary care clinic, emergency department, or gastroenterology practice, understanding how to navigate codes like K62.5, K92.2, and K92.1 will help you document hematochezia cases effectively.
