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ICD-10 Guide
ICD-10 CodesK57.31

K57.31

Billable

Diverticulosis of large intestine without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.31 is a billable code used to indicate a diagnosis of diverticulosis of large intestine without perforation or abscess with bleeding.

Key Diagnostic Point:

Diverticulosis of the large intestine is a condition 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. In K57.31, the diverticulosis is specified as occurring without perforation or abscess but with bleeding. Clinically, patients may present with symptoms such as abdominal pain, changes in bowel habits, and rectal bleeding. The anatomy involved primarily includes the sigmoid colon, where diverticula are most commonly found. Disease progression can lead to diverticulitis if inflammation occurs, but in this case, the absence of perforation or abscess indicates a less severe form of the disease. Diagnostic considerations include imaging studies such as CT scans or colonoscopy to confirm the presence of diverticula and assess for any complications. The diagnosis of diverticulosis is often incidental during imaging for other gastrointestinal complaints.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diverticulosis and rule out other conditions.
  • Treatment complexity: Management may involve dietary modifications, medications, or surgical intervention in severe cases.
  • Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is necessary.
  • Coding specificity: Requires precise coding to differentiate between diverticulosis, diverticulitis, and other gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulosis as diverticulitis.
  • Documentation gaps: Incomplete records regarding the presence of bleeding or other symptoms.
  • Billing challenges: Potential denials if documentation does not clearly 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

Diverticulosis, particularly with bleeding, has significant clinical implications as it can lead to increased healthcare utilization, including emergency visits and hospitalizations. Understanding the epidemiology of diverticular disease is crucial, as it affects a substantial portion of the population, particularly older adults. Quality measures may focus on appropriate management strategies to prevent complications and improve patient outcomes.

ICD-9 vs ICD-10

Diverticulosis, particularly with bleeding, has significant clinical implications as it can lead to increased healthcare utilization, including emergency visits and hospitalizations. Understanding the epidemiology of diverticular disease is crucial, as it affects a substantial portion of the population, particularly older adults. Quality measures may focus on appropriate management strategies to prevent complications and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical evidence and that any procedures performed are appropriately coded. Common denials may arise from insufficient documentation or failure to provide evidence of bleeding. Best practices include thorough documentation of all clinical findings and ensuring that coding accurately reflects the patient's diagnosis and treatment plan.

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 K57.31?

K57.31 covers diverticulosis of the large intestine specifically when there is bleeding present but no perforation or abscess. It is important to differentiate this from diverticulitis, which involves inflammation and may present with more severe symptoms.

When should K57.31 be used instead of related codes?

K57.31 should be used when a patient has diverticulosis with documented bleeding. It is crucial to ensure that there are no signs of diverticulitis or other complications before selecting this code.

What documentation supports K57.31?

Documentation should include clinical notes detailing the patient's symptoms, results from imaging studies confirming diverticulosis, and any laboratory results indicating bleeding. Clear differentiation from other gastrointestinal conditions is essential.