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ICD-10 Guide
ICD-10 CodesK57.51

K57.51

Billable

Diverticulosis of both small and large intestine without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.51 is a billable code used to indicate a diagnosis of diverticulosis of both small and large intestine without perforation or abscess with bleeding.

Key Diagnostic Point:

Diverticulosis of both the small and large intestine is characterized by the presence of diverticula, which are small pouches that form in the wall of the intestines. This condition can occur in both the small and large intestines, although it is more commonly associated with the colon. Patients may present with symptoms such as abdominal pain, bloating, and changes in bowel habits. In cases of K57.51, the diverticulosis is noted to be without perforation or abscess, but with the presence of bleeding, which can manifest as hematochezia or melena. The disease progression may vary; while some patients remain asymptomatic, others may experience complications such as diverticulitis or significant gastrointestinal bleeding. Diagnostic considerations include imaging studies like CT scans or colonoscopy to confirm the presence of diverticula and assess for any complications. It is crucial for healthcare providers to differentiate between diverticulosis and diverticulitis, as the management and coding differ significantly.

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 documentation of symptoms, diagnostic tests, and treatment plans is necessary.
  • Coding specificity: Requires accurate coding to distinguish between diverticulosis and diverticulitis.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulosis as diverticulitis.
  • Documentation gaps: Incomplete records regarding the presence of bleeding or symptoms.
  • Billing challenges: Potential denials 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diverticulosis is a common gastrointestinal condition that can significantly impact population health, particularly among older adults. The presence of diverticulosis with bleeding can lead to increased healthcare utilization, including emergency visits and hospitalizations. Quality measures may focus on timely diagnosis and management to prevent complications. Understanding the epidemiology of diverticulosis helps in developing preventive strategies and improving patient outcomes.

ICD-9 vs ICD-10

Diverticulosis is a common gastrointestinal condition that can significantly impact population health, particularly among older adults. The presence of diverticulosis with bleeding can lead to increased healthcare utilization, including emergency visits and hospitalizations. Quality measures may focus on timely diagnosis and management to prevent complications. Understanding the epidemiology of diverticulosis helps in developing preventive strategies and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of diverticulosis and bleeding, as well as any treatments provided. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include thorough documentation of patient history, diagnostic tests, and treatment plans to support the coding and billing process.

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 K57.51?

K57.51 covers diverticulosis of both the small and large intestine that is not complicated by perforation or abscess but includes the presence of gastrointestinal bleeding. It is important to document the specific symptoms and diagnostic findings to support this code.

When should K57.51 be used instead of related codes?

K57.51 should be used when the patient has diverticulosis with bleeding but no signs of perforation or abscess. If the patient presents with diverticulitis or other complications, different codes such as K57.32 (Diverticulitis of both small and large intestine) should be utilized.

What documentation supports K57.51?

Documentation should include clinical findings such as the presence of diverticula, any reported bleeding, imaging results, and a thorough assessment of the patient's symptoms. Clear notes on the absence of perforation or abscess are also essential.