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ICD-10 Guide
ICD-10 CodesK22.5

K22.5

Billable

Diverticulum of esophagus, acquired

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

Code Description

ICD-10 K22.5 is a billable code used to indicate a diagnosis of diverticulum of esophagus, acquired.

Key Diagnostic Point:

K22.5 refers to an acquired diverticulum of the esophagus, a condition characterized by the formation of a pouch or sac-like structure in the esophageal wall. This diverticulum typically arises due to increased pressure within the esophagus, often as a result of conditions such as esophageal motility disorders or chronic inflammation. Clinically, patients may present with symptoms such as dysphagia (difficulty swallowing), regurgitation of undigested food, halitosis (bad breath), and chest pain. The anatomy involved includes the muscular layers of the esophagus, where the diverticulum can form at weak points, often in the cervical region or the lower esophagus. Disease progression can lead to complications such as aspiration pneumonia, esophagitis, or even perforation if left untreated. Diagnostic considerations include imaging studies such as barium swallow studies or endoscopy, which can help visualize the diverticulum and assess for any associated complications. Accurate diagnosis is crucial for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

General Surgery

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K22.5 lies in its potential complications, which can affect patient quality of life and lead to increased healthcare utilization. Understanding the epidemiology of esophageal diverticula can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring for complications and ensuring timely intervention, which can improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

The clinical significance of K22.5 lies in its potential complications, which can affect patient quality of life and lead to increased healthcare utilization. Understanding the epidemiology of esophageal diverticula can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring for complications and ensuring timely intervention, which can improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case, potential surgical interventions, and follow-up care. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical information is included in the medical record to support the diagnosis and any associated procedures.

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 K22.5?

K22.5 specifically covers acquired diverticula of the esophagus, which may arise from conditions such as esophageal motility disorders, chronic inflammation, or increased intraluminal pressure. It does not cover congenital diverticula or diverticula of other gastrointestinal organs.

When should K22.5 be used instead of related codes?

K22.5 should be used when the diverticulum is acquired and not congenital. It is important to differentiate it from other esophageal conditions such as esophagitis or strictures, which may require different coding.

What documentation supports K22.5?

Documentation should include clinical findings, imaging results, and any relevant history of esophageal disorders. A clear description of symptoms, diagnostic tests performed, and treatment plans should be included to support the use of K22.5.