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ICD-10 Guide
ICD-10 CodesK57.5

K57.5

Non-billable

Diverticular disease of both small and large intestine without perforation or abscess

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

Code Description

ICD-10 K57.5 is a used to indicate a diagnosis of diverticular disease of both small and large intestine without perforation or abscess.

Key Diagnostic Point:

K57.5 refers to diverticular disease affecting both the small and large intestines without complications such as perforation or abscess. This condition is characterized by the formation of diverticula, which are small pouches that can develop in the walls of the intestines, primarily due to increased intraluminal pressure and dietary factors. Clinically, patients may present with symptoms such as abdominal pain, bloating, changes in bowel habits, and occasionally, gastrointestinal bleeding. The disease progression can vary; while some patients remain asymptomatic, others may experience recurrent episodes of diverticulitis or complications if not managed appropriately. Diagnostic considerations include a thorough patient history, physical examination, and imaging studies such as CT scans to assess the extent of diverticular disease. Endoscopy may also be utilized to rule out other gastrointestinal disorders. Understanding the anatomy involved, particularly the colonic and small intestinal structures, is crucial for accurate diagnosis and treatment planning.

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, medications, or surgical intervention in severe cases.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: Requires differentiation from other diverticular diseases and gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis versus diverticular disease.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging findings.
  • Billing challenges: Denials may occur if documentation does not clearly 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

Diverticular disease is a prevalent condition that affects a significant portion of the population, particularly older adults. Its clinical significance lies in the potential for complications such as diverticulitis, which can lead to increased healthcare utilization and costs. Understanding the epidemiology of diverticular disease can inform public health initiatives aimed at dietary modifications and preventive strategies to reduce the incidence of complications. Quality measures related to diverticular disease management can improve patient outcomes and reduce hospital readmissions.

ICD-9 vs ICD-10

Diverticular disease is a prevalent condition that affects a significant portion of the population, particularly older adults. Its clinical significance lies in the potential for complications such as diverticulitis, which can lead to increased healthcare utilization and costs. Understanding the epidemiology of diverticular disease can inform public health initiatives aimed at dietary modifications and preventive strategies to reduce the incidence of complications. Quality measures related to diverticular disease management can improve patient outcomes and reduce hospital readmissions.

Reimbursement & Billing Impact

Reimbursement considerations include the need for comprehensive clinical notes that detail the patient's symptoms, diagnostic tests performed, and treatment plans. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity. Coders should ensure that the selected CPT codes align with the diagnosis and that modifiers are used appropriately to reflect any additional services provided.

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 K57.5?

K57.5 covers diverticular disease of both the small and large intestines without perforation or abscess. This includes the presence of diverticula and associated symptoms without acute complications.

When should K57.5 be used instead of related codes?

K57.5 should be used when the patient has diverticular disease affecting both intestines without complications. It is important to differentiate it from K57.0 (diverticulitis) and K57.1 (diverticulosis) based on the presence of symptoms and imaging findings.

What documentation supports K57.5?

Documentation should include a detailed patient history, physical examination findings, imaging results (such as CT scans), and any relevant laboratory tests that support the diagnosis of diverticular disease without complications.