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ICD-10 Guide
ICD-10 CodesK57.3

K57.3

Non-billable

Diverticular disease of large intestine without perforation or abscess

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

Code Description

ICD-10 K57.3 is a used to indicate a diagnosis of diverticular disease of large intestine without perforation or abscess.

Key Diagnostic Point:

Diverticular disease of the large intestine without perforation or abscess is characterized by the presence of diverticula, which are small bulging pouches that can form in the lining of the digestive system, particularly in the colon. Clinically, patients may present with symptoms such as abdominal pain, bloating, changes in bowel habits, and occasionally, mild gastrointestinal bleeding. The anatomy involved primarily includes the sigmoid colon, where diverticula are most commonly found. Disease progression can lead to complications such as diverticulitis, though in the case of K57.3, there is no perforation or abscess present. Diagnostic considerations include a thorough patient history, physical examination, and imaging studies such as CT scans or colonoscopy to confirm the presence of diverticula and rule out other gastrointestinal disorders. Management typically involves dietary modifications, increased fiber intake, and in some cases, medications to manage symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires imaging and clinical evaluation.
  • Treatment complexity: Low to moderate, depending on symptom management.
  • Documentation requirements: Moderate, necessitating detailed clinical notes.
  • Coding specificity: High, as it specifically identifies the condition without complications.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis versus diverticular disease.
  • Documentation gaps: Incomplete patient history or lack of imaging results.
  • Billing challenges: Denials due to insufficient documentation of symptoms or treatment plans.

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

Diverticular disease is prevalent in the adult population, particularly among those over 50 years of age. Its clinical significance lies in the potential for complications, which can lead to increased healthcare utilization, including hospital admissions and surgical interventions. Understanding the epidemiology of diverticular disease can help healthcare providers implement preventive measures and improve patient outcomes through education on dietary modifications and lifestyle changes.

ICD-9 vs ICD-10

Diverticular disease is prevalent in the adult population, particularly among those over 50 years of age. Its clinical significance lies in the potential for complications, which can lead to increased healthcare utilization, including hospital admissions and surgical interventions. Understanding the epidemiology of diverticular disease can help healthcare providers implement preventive measures and improve patient outcomes through education on dietary modifications and lifestyle changes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services billed. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the procedures performed. Best practices include maintaining thorough clinical notes and ensuring that all relevant information is included in the claim submission to avoid delays or denials.

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 K57.3?

K57.3 covers diverticular disease of the large intestine without any associated complications such as perforation or abscess. It includes patients with diverticula who may experience symptoms but do not have acute diverticulitis.

When should K57.3 be used instead of related codes?

K57.3 should be used when a patient has diverticular disease without complications. If the patient presents with diverticulitis or complications such as perforation or abscess, codes K57.0 or K57.1 should be utilized instead.

What documentation supports K57.3?

Documentation should include a detailed patient history, physical examination findings, imaging reports confirming the presence of diverticula, and any treatment plans or dietary recommendations made by the healthcare provider.