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ICD-10 Guide
ICD-10 CodesK57.92

K57.92

Billable

Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.92 is a billable code used to indicate a diagnosis of diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding.

Key Diagnostic Point:

K57.92 refers to diverticulitis of the intestine, part unspecified, without perforation or abscess, and without bleeding. Diverticulitis occurs when diverticula, which are small pouches that can form in the walls of the intestines, become inflamed or infected. This condition typically presents with symptoms such as abdominal pain, fever, and changes in bowel habits, including constipation or diarrhea. The anatomy involved primarily includes the colon, where diverticula are most commonly found, particularly in the sigmoid region. Disease progression can vary; mild cases may resolve with conservative management, while more severe cases can lead to complications if not treated. Diagnostic considerations include a thorough patient history, physical examination, and imaging studies such as CT scans, which can help confirm the diagnosis and rule out complications like perforation or abscess formation. Laboratory tests may also be conducted to assess for infection or inflammation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm
  • Treatment complexity: Management may vary from outpatient care to hospitalization
  • Documentation requirements: Detailed clinical notes and imaging results needed
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal conditions

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 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 is a common gastrointestinal condition that affects a significant portion of the population, particularly older adults. The clinical significance lies in its potential to lead to severe complications if left untreated, impacting healthcare utilization patterns due to increased hospital admissions and surgeries. Understanding and accurately coding K57.92 can improve quality measures by ensuring appropriate management of patients and reducing the risk of complications, ultimately enhancing population health outcomes.

ICD-9 vs ICD-10

Diverticulitis is a common gastrointestinal condition that affects a significant portion of the population, particularly older adults. The clinical significance lies in its potential to lead to severe complications if left untreated, impacting healthcare utilization patterns due to increased hospital admissions and surgeries. Understanding and accurately coding K57.92 can improve quality measures by ensuring appropriate management of patients and reducing the risk of complications, ultimately enhancing population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for imaging and treatment is clearly documented. Common denials may arise from insufficient documentation or failure to demonstrate the absence of complications. Best practices include maintaining thorough clinical notes, ensuring that all relevant diagnostic tests are documented, and using appropriate modifiers when necessary to clarify the nature of the treatment 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 K57.92?

K57.92 covers cases of diverticulitis without complications such as perforation, abscess, or bleeding. It is specifically used when the diverticulitis is not localized to a specific part of the intestine.

When should K57.92 be used instead of related codes?

K57.92 should be used when the patient presents with diverticulitis that is not complicated by perforation, abscess, or bleeding. If any of these complications are present, other codes such as K57.21 or K57.31 should be selected.

What documentation supports K57.92?

Documentation should include a clear diagnosis of diverticulitis, clinical symptoms, results from imaging studies, and any treatment plans. It is essential to document the absence of complications to justify the use of K57.92.