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ICD-10 Guide
ICD-10 CodesK57.30

K57.30

Billable

Diverticulosis of large intestine without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.30 is a billable code used to indicate a diagnosis of diverticulosis of large intestine without perforation or abscess without bleeding.

Key Diagnostic Point:

Diverticulosis of the large intestine is characterized by the presence of diverticula, which are small, bulging pouches that can form in the lining of the digestive system, particularly in the colon. This condition is often asymptomatic but can lead to complications if not monitored. The anatomy involved includes the large intestine, specifically the sigmoid colon, where diverticula are most commonly found. Disease progression can vary; while many individuals remain asymptomatic, some may experience abdominal discomfort, bloating, or changes in bowel habits. Diagnostic considerations include imaging studies such as CT scans or colonoscopy, which can help visualize the diverticula and rule out other conditions. It is crucial to differentiate diverticulosis from diverticulitis, which involves inflammation and can lead to perforation or abscess formation. K57.30 specifically denotes diverticulosis without these complications, making it essential for accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: Management may include dietary modifications and monitoring.
  • Documentation requirements: Detailed patient history and imaging results are necessary.
  • Coding specificity: Accurate coding is essential to differentiate from diverticulitis.

Audit Risk Factors

  • Common coding errors: Misclassification between diverticulosis and diverticulitis.
  • Documentation gaps: Lack of clear imaging reports or clinical notes.
  • 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diverticulosis is prevalent in the aging population, impacting healthcare utilization patterns as patients may require regular monitoring and dietary counseling. Understanding the epidemiology of diverticulosis can help healthcare providers implement preventive measures and improve patient education. Quality measures may include tracking the incidence of diverticulitis in patients with diverticulosis, which can inform population health strategies aimed at reducing complications.

ICD-9 vs ICD-10

Diverticulosis is prevalent in the aging population, impacting healthcare utilization patterns as patients may require regular monitoring and dietary counseling. Understanding the epidemiology of diverticulosis can help healthcare providers implement preventive measures and improve patient education. Quality measures may include tracking the incidence of diverticulitis in patients with diverticulosis, which can inform population health strategies aimed at reducing complications.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly documented in the medical record, as insurers may deny claims if the documentation does not align with the diagnosis. Common denials may arise from misclassification or insufficient documentation. Best practices include maintaining clear and concise notes on patient symptoms, imaging results, and any dietary recommendations provided to the patient.

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 K57.30?

K57.30 covers diverticulosis of the large intestine without any associated complications such as perforation, abscess, or bleeding. It is important to note that this code is used when the patient is asymptomatic or has mild symptoms that do not indicate diverticulitis.

When should K57.30 be used instead of related codes?

K57.30 should be used when the diagnosis is confirmed as diverticulosis without complications. If the patient presents with symptoms indicative of diverticulitis, such as fever or severe abdominal pain, then K57.31 or K57.32 should be considered instead.

What documentation supports K57.30?

Documentation should include a thorough patient history, physical examination findings, and results from imaging studies such as CT scans or colonoscopy that confirm the presence of diverticula without signs of inflammation or other complications.