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ICD-10 Guide
ICD-10 CodesK57.01

K57.01

Billable

Diverticulitis of small intestine with perforation and abscess with bleeding

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

Code Description

ICD-10 K57.01 is a billable code used to indicate a diagnosis of diverticulitis of small intestine with perforation and abscess with bleeding.

Key Diagnostic Point:

Diverticulitis of the small intestine with perforation and abscess with bleeding is a serious gastrointestinal condition characterized by inflammation of diverticula, which are small pouches that can form in the walls of the intestine. In this specific case, the diverticulitis has progressed to a perforation, leading to the formation of an abscess and associated bleeding. Clinically, patients may present with acute abdominal pain, fever, nausea, and changes in bowel habits. The small intestine, particularly the ileum, is involved, and the condition can lead to significant complications if not treated promptly. Disease progression can vary, but it often involves an initial episode of diverticulitis that can worsen, leading to perforation and abscess formation. Diagnostic considerations include imaging studies such as CT scans, which can reveal the presence of diverticula, abscesses, and any associated bleeding. Laboratory tests may show leukocytosis and signs of infection. Early diagnosis and intervention are crucial to prevent severe complications such as sepsis or peritonitis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and laboratory tests to confirm diagnosis.
  • Treatment complexity: May necessitate surgical intervention, antibiotics, and management of complications.
  • Documentation requirements: Detailed clinical documentation is needed to support the diagnosis and treatment.
  • Coding specificity: Requires precise coding to capture the severity and specifics of the condition.

Audit Risk Factors

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

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 is a significant clinical concern due to its potential for severe complications, including sepsis and increased healthcare utilization. The condition can lead to higher rates of hospitalization and surgical interventions, impacting population health. Quality measures related to timely diagnosis and treatment are crucial, as delays can result in worse outcomes. Understanding the epidemiology of diverticulitis, including risk factors such as age and dietary habits, can help healthcare providers implement preventive strategies and improve patient care.

ICD-9 vs ICD-10

Diverticulitis with perforation and abscess is a significant clinical concern due to its potential for severe complications, including sepsis and increased healthcare utilization. The condition can lead to higher rates of hospitalization and surgical interventions, impacting population health. Quality measures related to timely diagnosis and treatment are crucial, as delays can result in worse outcomes. Understanding the epidemiology of diverticulitis, including risk factors such as age and dietary habits, can help healthcare providers implement preventive strategies and improve patient care.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for surgical interventions. It is essential to ensure that all relevant clinical notes, imaging results, and treatment plans are clearly documented to support the coding and billing process. Following coding best practices, including the use of modifiers when applicable, can help mitigate 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 K57.01?

K57.01 specifically covers diverticulitis of the small intestine that has progressed to include perforation, abscess formation, and bleeding. It is critical to differentiate this from other forms of diverticulitis that do not involve these complications.

When should K57.01 be used instead of related codes?

K57.01 should be used when there is clear evidence of perforation, abscess, and bleeding associated with diverticulitis of the small intestine. If these complications are not present, other codes such as K57.00 may be more appropriate.

What documentation supports K57.01?

Documentation should include clinical findings such as imaging results showing perforation and abscess, laboratory results indicating infection or bleeding, and a detailed account of the patient's symptoms and treatment plan.