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ICD-10 Guide
ICD-10 CodesK57.11

K57.11

Billable

Diverticulosis of small intestine without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.11 is a billable code used to indicate a diagnosis of diverticulosis of small intestine without perforation or abscess with bleeding.

Key Diagnostic Point:

K57.11 refers to diverticulosis of the small intestine without perforation or abscess, accompanied by bleeding. This condition is characterized by the presence of diverticula, which are small pouches that form in the wall of the small intestine. Clinically, patients may present with symptoms such as abdominal pain, bloating, and changes in bowel habits, although many may be asymptomatic. The anatomy involved primarily includes the small intestine, particularly the jejunum and ileum, where diverticula can develop. Disease progression can lead to complications such as diverticulitis if inflammation occurs, but in K57.11, the absence of perforation or abscess indicates a less severe state. Diagnostic considerations include imaging studies such as CT scans or endoscopy to visualize diverticula and assess for bleeding sources. Laboratory tests may also be performed to evaluate hemoglobin levels in cases of significant bleeding. Accurate diagnosis is crucial for appropriate management and to differentiate from other gastrointestinal disorders.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diverticulosis and assess for bleeding.
  • Treatment complexity: Management may involve dietary modifications, medications, or surgical intervention in severe cases.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and any associated symptoms.
  • Coding specificity: Requires precise coding to differentiate from diverticulitis and other gastrointestinal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulosis as diverticulitis.
  • Documentation gaps: Incomplete clinical notes regarding the presence of bleeding or symptoms.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis or if the bleeding is not adequately addressed.

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

The clinical significance of K57.11 lies in its potential to lead to more severe gastrointestinal complications if not managed appropriately. Population health impact includes the prevalence of diverticular disease, which affects a significant portion of the adult population, particularly those over 40. Quality measures may focus on timely diagnosis and management of diverticulosis to prevent complications. Understanding healthcare utilization patterns is crucial, as patients with diverticulosis may require frequent medical visits and interventions, impacting overall healthcare costs and resource allocation.

ICD-9 vs ICD-10

The clinical significance of K57.11 lies in its potential to lead to more severe gastrointestinal complications if not managed appropriately. Population health impact includes the prevalence of diverticular disease, which affects a significant portion of the adult population, particularly those over 40. Quality measures may focus on timely diagnosis and management of diverticulosis to prevent complications. Understanding healthcare utilization patterns is crucial, as patients with diverticulosis may require frequent medical visits and interventions, impacting overall healthcare costs and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include the potential for higher payment rates due to the complexity of managing bleeding diverticulosis. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the diagnosis. Adhering to coding best practices, including accurate code selection and comprehensive clinical documentation, is essential for successful billing.

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 K57.11?

K57.11 specifically covers diverticulosis of the small intestine that is not complicated by perforation or abscess but is associated with bleeding. This includes cases where patients may experience gastrointestinal bleeding due to the presence of diverticula.

When should K57.11 be used instead of related codes?

K57.11 should be used when there is a confirmed diagnosis of diverticulosis of the small intestine with documented bleeding, differentiating it from K57.10, which does not include bleeding, and K57.12, which involves complications such as perforation or abscess.

What documentation supports K57.11?

Documentation supporting K57.11 should include clinical notes detailing the diagnosis of diverticulosis, evidence of bleeding (such as lab results indicating anemia or imaging findings), and any relevant symptoms or treatment plans.