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ICD-10 Guide
ICD-10 CodesK57.80

K57.80

Billable

Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding

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

Code Description

ICD-10 K57.80 is a billable code used to indicate a diagnosis of diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding.

Key Diagnostic Point:

K57.80 refers to diverticulitis of the intestine, part unspecified, with perforation and abscess without bleeding. This condition arises when diverticula, small pouches that can form in the walls of the intestines, become inflamed or infected. The inflammation can lead to perforation, allowing intestinal contents to leak into the abdominal cavity, which may result in the formation of an abscess. Clinically, patients may present with symptoms such as abdominal pain, fever, nausea, and changes in bowel habits. The anatomy involved primarily includes the colon, where diverticula are most commonly found, though they can occur in other parts of the intestine. Disease progression can vary; if untreated, it may lead to severe complications like peritonitis or sepsis. Diagnostic considerations include imaging studies such as CT scans to confirm the presence of diverticulitis, perforation, and abscess formation. Laboratory tests may also be conducted to assess for infection and inflammation. Accurate diagnosis is crucial for appropriate management, which may involve antibiotics, dietary modifications, or surgical intervention depending on the severity of the condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying diverticulitis severity or failing to document abscess formation.
  • Documentation gaps may arise if the clinical notes do not clearly indicate the presence of perforation or abscess.
  • Billing challenges can occur if the medical necessity for surgical intervention is not well-supported by documentation.

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

General Surgery

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

Diverticulitis with perforation and abscess is a significant clinical condition that can lead to severe complications if not managed promptly. Its impact on population health is notable, as it can result in increased healthcare utilization, including hospital admissions and surgical interventions. Quality measures often focus on timely diagnosis and treatment to prevent complications, highlighting the importance of effective management strategies in reducing morbidity associated with this condition.

ICD-9 vs ICD-10

Diverticulitis with perforation and abscess is a significant clinical condition that can lead to severe complications if not managed promptly. Its impact on population health is notable, as it can result in increased healthcare utilization, including hospital admissions and surgical interventions. Quality measures often focus on timely diagnosis and treatment to prevent complications, highlighting the importance of effective management strategies in reducing morbidity associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for surgical procedures. Best practices include maintaining thorough clinical notes, ensuring imaging studies are documented, and using the appropriate modifiers when applicable to support the claim.

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 K57.80?

K57.80 specifically covers diverticulitis of the intestine with perforation and abscess formation, without any associated bleeding. It is important to differentiate this from other forms of diverticulitis that may not involve these complications.

When should K57.80 be used instead of related codes?

K57.80 should be used when there is clear documentation of diverticulitis with both perforation and abscess, without any bleeding. If there is no perforation or abscess, other codes such as K57.00 should be considered.

What documentation supports K57.80?

Documentation should include clinical findings that confirm the diagnosis of diverticulitis, imaging results showing perforation and abscess, and any treatment plans that reflect the severity of the condition.