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ICD-10 Guide
ICD-10 CodesK57.10

K57.10

Billable

Diverticulosis of small intestine without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.10 is a billable code used to indicate a diagnosis of diverticulosis of small intestine without perforation or abscess without bleeding.

Key Diagnostic Point:

Diverticulosis of the small intestine is characterized by the presence of diverticula, which are small pouches that form in the intestinal wall. This condition typically arises due to increased intraluminal pressure and is often asymptomatic. Patients may present with abdominal discomfort, bloating, or changes in bowel habits, although many remain symptom-free. The small intestine, particularly the ileum, is involved, and the disease can progress to diverticulitis if inflammation occurs, but in this case, there is no perforation, abscess, or bleeding. Diagnosis is usually made through imaging studies such as CT scans or MRI, which can reveal the diverticula. Endoscopy may also be utilized to visualize the intestinal lining. It is essential to differentiate diverticulosis from diverticulitis, as the management strategies differ significantly. Regular monitoring and dietary modifications are often recommended to prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: Management may involve dietary changes and monitoring, but surgery is not typically needed unless complications arise.
  • Documentation requirements: Accurate documentation of symptoms, imaging results, and patient history is crucial.
  • Coding specificity: Requires precise coding to differentiate from diverticulitis and other gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulosis as diverticulitis.
  • Documentation gaps: Lack of detailed patient history or imaging results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

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 of the small intestine, while often asymptomatic, can impact population health through potential progression to diverticulitis, which may require surgical intervention. Understanding the epidemiology of diverticulosis helps in developing preventive strategies and managing healthcare resources effectively. Quality measures focusing on dietary management and patient education can improve outcomes and reduce healthcare utilization associated with complications.

ICD-9 vs ICD-10

Diverticulosis of the small intestine, while often asymptomatic, can impact population health through potential progression to diverticulitis, which may require surgical intervention. Understanding the epidemiology of diverticulosis helps in developing preventive strategies and managing healthcare resources effectively. Quality measures focusing on dietary management and patient education can improve outcomes and reduce healthcare utilization associated with complications.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer, and it is crucial to follow specific guidelines for coding and billing. Common denials may arise from insufficient documentation or misclassification of the condition. To mitigate these risks, coders should ensure that all relevant clinical information is included in the medical record, and that the coding aligns with the documented diagnosis. Regular training on coding updates and payer policies can also enhance billing accuracy.

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 K57.10?

K57.10 specifically covers diverticulosis of the small intestine without any associated complications such as perforation, abscess, or bleeding. It is important to note that this code does not apply to diverticulitis or diverticulosis of the colon.

When should K57.10 be used instead of related codes?

K57.10 should be used when a patient has confirmed diverticulosis of the small intestine without any complications. If there are signs of inflammation or infection, K57.11 (Diverticulitis) would be more appropriate.

What documentation supports K57.10?

Documentation should include clinical findings, imaging results confirming diverticulosis, and a thorough patient history. It is essential to document the absence of complications such as perforation or abscess.