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ICD-10 Guide
ICD-10 CodesK57.52

K57.52

Billable

Diverticulitis of both small and large intestine without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.52 is a billable code used to indicate a diagnosis of diverticulitis of both small and large intestine without perforation or abscess without bleeding.

Key Diagnostic Point:

K57.52 refers to diverticulitis affecting both the small and large intestines without complications such as perforation, abscess, or bleeding. Diverticulitis occurs when diverticula, small pouches that can form in the lining of the digestive system, become inflamed or infected. This condition can present with symptoms including abdominal pain, fever, and changes in bowel habits. The anatomy involved primarily includes the colon and, in this case, the small intestine, which may be affected concurrently. Disease progression can vary; while some patients may experience mild symptoms, others may have more severe manifestations requiring medical intervention. Diagnostic considerations include a thorough patient history, physical examination, and imaging studies such as CT scans to confirm the diagnosis and rule out complications. It is essential to differentiate K57.52 from other diverticular diseases, particularly those with complications, to ensure appropriate management and coding.

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, antibiotics, or surgery in severe cases.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis.
  • Coding specificity: Must accurately reflect the absence of complications.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis severity.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • 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

Diverticulitis, particularly in its uncomplicated form, significantly impacts population health due to its prevalence in adults, especially those over 40. Quality measures focus on timely diagnosis and management to prevent complications. Understanding healthcare utilization patterns for this condition can help in resource allocation and improving patient outcomes. Epidemiologically, the rising incidence of diverticular disease underscores the importance of awareness and preventive strategies in the healthcare system.

ICD-9 vs ICD-10

Diverticulitis, particularly in its uncomplicated form, significantly impacts population health due to its prevalence in adults, especially those over 40. Quality measures focus on timely diagnosis and management to prevent complications. Understanding healthcare utilization patterns for this condition can help in resource allocation and improving patient outcomes. Epidemiologically, the rising incidence of diverticular disease underscores the importance of awareness and preventive strategies in the healthcare system.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation that supports the diagnosis and treatment provided. Common denials may arise from insufficient clinical evidence or misclassification of the condition. It is essential to ensure that all documentation aligns with the coding to avoid billing challenges and ensure proper reimbursement for services rendered.

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 K57.52?

K57.52 covers diverticulitis of both the small and large intestines without perforation, abscess, or bleeding. It is characterized by inflammation of diverticula in these regions, leading to abdominal pain and other gastrointestinal symptoms.

When should K57.52 be used instead of related codes?

K57.52 should be used when the patient presents with diverticulitis affecting both intestines without any complications. If there are signs of perforation, abscess, or bleeding, other specific codes should be selected.

What documentation supports K57.52?

Documentation should include clinical findings such as abdominal pain, imaging results confirming diverticulitis, and a treatment plan. Clear notes on the absence of complications are crucial for accurate coding.