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ICD-10 Guide
ICD-10 CodesK57.2

K57.2

Non-billable

Diverticulitis of large intestine with perforation and abscess

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

Code Description

ICD-10 K57.2 is a used to indicate a diagnosis of diverticulitis of large intestine with perforation and abscess.

Key Diagnostic Point:

Diverticulitis of the large intestine with perforation and abscess is a severe complication of diverticulitis, characterized by inflammation and infection of diverticula in the colon. Clinically, patients may present with acute abdominal pain, fever, nausea, and changes in bowel habits. The anatomy involved primarily includes the sigmoid colon, where diverticula are most commonly formed due to increased intraluminal pressure. Disease progression can lead to localized or generalized peritonitis if perforation occurs, resulting in the formation of an abscess. Diagnostic considerations include imaging studies such as CT scans, which can reveal the presence of diverticula, inflammation, and abscess formation. Laboratory tests may show leukocytosis and elevated inflammatory markers. Early recognition and management are crucial to prevent complications such as sepsis or bowel obstruction.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation to confirm perforation and abscess.
  • Treatment complexity: Often necessitates surgical intervention, including possible resection of affected bowel.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other forms of diverticulitis.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis severity.
  • Documentation gaps: Incomplete clinical notes regarding the presence of perforation or abscess.
  • Billing challenges: Denials may arise from insufficient documentation supporting the severity of the condition.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diverticulitis with perforation and abscess has significant clinical implications, often leading to increased healthcare utilization due to hospitalizations and surgical interventions. It affects a substantial portion of the population, particularly older adults, and can lead to serious complications if not managed promptly. Quality measures focus on timely diagnosis and treatment to reduce morbidity and mortality associated with this condition.

ICD-9 vs ICD-10

Diverticulitis with perforation and abscess has significant clinical implications, often leading to increased healthcare utilization due to hospitalizations and surgical interventions. It affects a substantial portion of the population, particularly older adults, and can lead to serious complications if not managed promptly. Quality measures focus on timely diagnosis and treatment to reduce morbidity and mortality associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case, with higher reimbursement rates for surgical procedures. Common denials may occur if documentation does not clearly support the diagnosis of perforation and abscess. Best practices include ensuring that all clinical notes are complete and that imaging results are readily available to support the coding.

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 K57.2?

K57.2 specifically covers diverticulitis of the large intestine that has progressed to include perforation and abscess formation. This condition is characterized by severe inflammation and infection, requiring immediate medical attention.

When should K57.2 be used instead of related codes?

K57.2 should be used when there is clear evidence of perforation and abscess in the context of diverticulitis. If the diverticulitis is uncomplicated or without perforation, codes such as K57.0 or K57.1 should be used instead.

What documentation supports K57.2?

Documentation supporting K57.2 should include imaging results (e.g., CT scans) showing perforation and abscess, clinical notes detailing symptoms, and treatment plans that reflect the severity of the condition.