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ICD-10 Guide
ICD-10 CodesK57.12

K57.12

Billable

Diverticulitis of small intestine without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.12 is a billable code used to indicate a diagnosis of diverticulitis of small intestine without perforation or abscess without bleeding.

Key Diagnostic Point:

Diverticulitis of the small intestine without perforation or abscess and without bleeding is characterized by inflammation of diverticula, which are small pouches that can form in the lining of the small intestine. Clinically, patients may present with abdominal pain, particularly in the lower abdomen, along with symptoms such as nausea, vomiting, and changes in bowel habits. The anatomy involved primarily includes the small intestine, particularly the ileum, where diverticula are most commonly found. Disease progression can lead to complications if not managed appropriately, including the potential for perforation or abscess formation, although these are not present in this specific diagnosis. Diagnostic considerations typically involve imaging studies such as CT scans or ultrasound to confirm the presence of diverticulitis and rule out other gastrointestinal conditions. Laboratory tests may also be performed to assess for signs of infection or inflammation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: Management may include dietary modifications, antibiotics, and in some cases, surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of diverticulitis and gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis severity.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging results.
  • 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 of the small intestine, while less common than that of the large intestine, can significantly impact patient quality of life and healthcare utilization. Effective management can reduce hospital admissions and complications, thereby improving population health outcomes. Awareness and proper coding of this condition are essential for tracking epidemiological trends and ensuring appropriate resource allocation in healthcare systems.

ICD-9 vs ICD-10

Diverticulitis of the small intestine, while less common than that of the large intestine, can significantly impact patient quality of life and healthcare utilization. Effective management can reduce hospital admissions and complications, thereby improving population health outcomes. Awareness and proper coding of this condition are essential for tracking epidemiological trends and ensuring appropriate resource allocation in healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for imaging and treatment is clearly documented. Common denials may occur if the documentation does not adequately reflect the severity of the condition or if there is a lack of supporting evidence for the diagnosis. Best practices include thorough clinical notes, clear imaging reports, and adherence to coding guidelines to minimize audit risks.

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 K57.12?

K57.12 specifically covers diverticulitis of the small intestine that is not complicated by perforation, abscess, or bleeding. It is crucial to differentiate this from other gastrointestinal conditions such as Crohn's disease or diverticulitis of the large intestine.

When should K57.12 be used instead of related codes?

K57.12 should be used when the patient presents with diverticulitis of the small intestine without any complications. If there are signs of perforation, abscess, or bleeding, then other codes such as K57.11 or K57.13 should be considered.

What documentation supports K57.12?

Documentation should include clinical notes detailing the patient's symptoms, results from imaging studies confirming diverticulitis, and any treatment plans. It is essential to have clear evidence that there are no complications such as perforation or abscess.