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ICD-10 Guide
ICD-10 CodesK57.0

K57.0

Non-billable

Diverticulitis of small intestine with perforation and abscess

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

Code Description

ICD-10 K57.0 is a used to indicate a diagnosis of diverticulitis of small intestine with perforation and abscess.

Key Diagnostic Point:

Diverticulitis of the small intestine with perforation and abscess is a serious gastrointestinal condition characterized by the inflammation of diverticula, which are small pouches that can form in the walls of the intestines. In this specific case, the diverticulitis has progressed to a perforation, leading to the leakage of intestinal contents into the abdominal cavity, which can result in peritonitis and abscess formation. Clinically, patients may present with severe abdominal pain, fever, nausea, vomiting, and changes in bowel habits. The small intestine, particularly the ileum, is involved in this condition, and the disease can progress rapidly if not treated promptly. Diagnostic considerations include imaging studies such as CT scans, which can reveal the presence of abscesses and perforations. Laboratory tests may show leukocytosis indicating infection. Early intervention is crucial to prevent complications, and treatment often involves antibiotics and surgical intervention to repair the perforation and drain any abscesses.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: Often necessitates surgical intervention and management of complications.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of diverticulitis.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis severity or failure to document perforation.
  • Documentation gaps: Incomplete clinical notes regarding the patient's condition and treatment.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diverticulitis with perforation and abscess has significant clinical implications, including increased morbidity and healthcare utilization due to the need for surgical intervention and prolonged hospitalization. It affects a substantial portion of the population, particularly older adults, and can lead to complications that impact overall health outcomes. Understanding the epidemiology of this condition is vital for improving quality measures and managing healthcare resources effectively.

ICD-9 vs ICD-10

Diverticulitis with perforation and abscess has significant clinical implications, including increased morbidity and healthcare utilization due to the need for surgical intervention and prolonged hospitalization. It affects a substantial portion of the population, particularly older adults, and can lead to complications that impact overall health outcomes. Understanding the epidemiology of this condition is vital for improving quality measures and managing healthcare resources effectively.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition, the necessity for surgical intervention, and the associated costs of care. Common denials may arise from inadequate documentation or failure to demonstrate medical necessity for procedures performed. Coders should ensure that all relevant clinical information is captured in the medical record to support the claim and 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 K57.0?

K57.0 specifically covers diverticulitis of the small intestine that has progressed to include perforation and abscess formation. This condition is characterized by inflammation, infection, and potential complications such as peritonitis.

When should K57.0 be used instead of related codes?

K57.0 should be used when there is clear evidence of perforation and abscess in the small intestine. If the diverticulitis is uncomplicated or without perforation, other codes such as K57.1 should be considered.

What documentation supports K57.0?

Documentation must include clinical findings of diverticulitis, imaging results showing perforation and abscess, laboratory results indicating infection, and a detailed treatment plan outlining surgical or medical management.