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ICD-10 Guide
ICD-10 CodesK57.00

K57.00

Billable

Diverticulitis of small intestine with perforation and abscess without bleeding

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

Code Description

ICD-10 K57.00 is a billable code used to indicate a diagnosis of diverticulitis of small intestine with perforation and abscess without bleeding.

Key Diagnostic Point:

Diverticulitis of the small intestine with perforation and abscess without bleeding is a serious gastrointestinal condition characterized by inflammation and infection of diverticula, which are small pouches that can form in the intestinal wall. In this specific case, the diverticulitis has progressed to a perforation, leading to the formation of an abscess. Clinically, patients may present with acute abdominal pain, fever, nausea, and changes in bowel habits. The small intestine, particularly the ileum, is involved in this condition, which can lead to complications such as peritonitis if not treated promptly. Disease progression can vary, but it often involves an initial episode of diverticulitis that worsens due to factors such as dietary habits, obesity, and lack of physical activity. Diagnostic considerations include imaging studies like CT scans to confirm the presence of diverticula, perforation, and abscess formation. Laboratory tests may also indicate infection or inflammation. Early diagnosis and intervention are critical to prevent severe complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: Often necessitates surgical intervention and management of complications.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • 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 the extent of disease.
  • Billing challenges: Potential denials due to lack of supporting documentation for surgical procedures.

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 has significant clinical implications, including increased morbidity and potential mortality if not managed appropriately. It affects a substantial portion of the population, particularly older adults, leading to increased healthcare utilization and costs. Quality measures focus on timely diagnosis and intervention to reduce complications and improve patient outcomes. Understanding the epidemiology of this condition can aid in developing preventive strategies and improving overall population health.

ICD-9 vs ICD-10

Diverticulitis with perforation and abscess has significant clinical implications, including increased morbidity and potential mortality if not managed appropriately. It affects a substantial portion of the population, particularly older adults, leading to increased healthcare utilization and costs. Quality measures focus on timely diagnosis and intervention to reduce complications and improve patient outcomes. Understanding the epidemiology of this condition can aid in developing preventive strategies and improving overall population health.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity of surgical procedures. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for surgery. It is essential to ensure that all relevant clinical information is included in the patient's medical record 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 K57.00?

K57.00 specifically covers diverticulitis of the small intestine that has progressed to include perforation and abscess formation, without any associated bleeding. It is crucial to differentiate this from other diverticular diseases and gastrointestinal conditions.

When should K57.00 be used instead of related codes?

K57.00 should be used when there is clear evidence of perforation and abscess formation in the small intestine due to diverticulitis. If the condition does not involve these complications, other codes such as K57.01 should be considered.

What documentation supports K57.00?

Documentation for K57.00 should include clinical findings, imaging results confirming perforation and abscess, laboratory tests indicating infection, and detailed notes on the patient's symptoms and treatment plan.