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ICD-10 Guide
ICD-10 CodesK57.91

K57.91

Billable

Diverticulosis of intestine, part unspecified, without perforation or abscess with bleeding

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K57.91 is a billable code used to indicate a diagnosis of diverticulosis of intestine, part unspecified, without perforation or abscess with bleeding.

Key Diagnostic Point:

K57.91 refers to diverticulosis of the intestine, part unspecified, without perforation or abscess, accompanied by bleeding. Diverticulosis is characterized by the formation of small pouches (diverticula) that protrude from the wall of the intestine, primarily the colon. These pouches develop due to increased pressure within the colon, often associated with a low-fiber diet, aging, and certain lifestyle factors. Clinically, patients may present with symptoms such as abdominal pain, bloating, and changes in bowel habits, although many remain asymptomatic. The bleeding associated with K57.91 can occur when a diverticulum erodes into a blood vessel, leading to hematochezia. Diagnosis typically involves imaging studies such as a CT scan or colonoscopy, which can help visualize diverticula and assess for complications. It is crucial to differentiate diverticulosis from diverticulitis, which involves inflammation and can lead to more severe complications like perforation or abscess formation. Understanding the progression of diverticulosis is essential for managing potential complications and guiding treatment options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying diverticulosis as diverticulitis.
  • Documentation gaps may arise if bleeding is not clearly noted in the medical record.
  • Billing challenges can occur if the clinical rationale for the diagnosis is not adequately supported.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diverticulosis is a prevalent condition, particularly among older adults, and its complications can significantly impact population health. The presence of diverticulosis with bleeding can lead to increased healthcare utilization, including emergency visits and hospital admissions. Understanding the epidemiology of diverticulosis is crucial for developing quality measures aimed at prevention and management, ultimately improving patient outcomes and reducing healthcare costs.

ICD-9 vs ICD-10

Diverticulosis is a prevalent condition, particularly among older adults, and its complications can significantly impact population health. The presence of diverticulosis with bleeding can lead to increased healthcare utilization, including emergency visits and hospital admissions. Understanding the epidemiology of diverticulosis is crucial for developing quality measures aimed at prevention and management, ultimately improving patient outcomes and reducing healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation of symptoms and any diagnostic tests performed. Common denials may arise from insufficient documentation or misclassification of the condition. Coders should ensure that the medical necessity for procedures related to K57.91 is well-documented, and that all relevant CPT codes are accurately reported to avoid billing challenges.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K57.91?

K57.91 specifically covers diverticulosis of the intestine without perforation or abscess, where the patient experiences bleeding. It does not include diverticulitis or other gastrointestinal conditions.

When should K57.91 be used instead of related codes?

K57.91 should be used when there is a confirmed diagnosis of diverticulosis with bleeding, and no evidence of perforation or abscess. If diverticulitis is suspected, K57.92 should be considered instead.

What documentation supports K57.91?

Documentation should include clinical findings of diverticulosis, evidence of bleeding (e.g., lab results showing anemia or stool tests), and a clear distinction from diverticulitis or other gastrointestinal disorders.