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ICD-10 Guide
ICD-10 CodesK57.33

K57.33

Billable

Diverticulitis of large intestine without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.33 is a billable code used to indicate a diagnosis of diverticulitis of large intestine without perforation or abscess with bleeding.

Key Diagnostic Point:

Diverticulitis of the large intestine without perforation or abscess with bleeding is characterized by inflammation of diverticula, which are small pouches that can form in the walls of the colon. Clinically, patients may present with symptoms such as abdominal pain, fever, changes in bowel habits, and rectal bleeding. The anatomy involved primarily includes the sigmoid colon, where diverticula are most commonly located. Disease progression can lead to complications if not managed appropriately, including the potential for abscess formation or perforation, although these are not present in this specific diagnosis. Diagnostic considerations include a thorough clinical history, physical examination, and imaging studies such as CT scans, which can help confirm the diagnosis and rule out other conditions. Laboratory tests may also be utilized to assess for infection or inflammation. Proper identification and coding of this condition are essential for effective treatment planning and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: Management may involve dietary changes, antibiotics, or surgery in severe cases.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other diverticular diseases.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis severity or complications.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or imaging results.
  • 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

Diverticulitis, particularly with bleeding, has significant clinical implications, affecting patient quality of life and healthcare utilization. It is a common gastrointestinal condition, especially in older adults, leading to increased hospital admissions and healthcare costs. Understanding the epidemiology of diverticulitis can help healthcare providers implement preventive measures and improve management strategies, ultimately enhancing patient outcomes and reducing the burden on healthcare systems.

ICD-9 vs ICD-10

Diverticulitis, particularly with bleeding, has significant clinical implications, affecting patient quality of life and healthcare utilization. It is a common gastrointestinal condition, especially in older adults, leading to increased hospital admissions and healthcare costs. Understanding the epidemiology of diverticulitis can help healthcare providers implement preventive measures and improve management strategies, ultimately enhancing patient outcomes and reducing the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for any procedures or treatments is clearly documented. Common denials may arise from insufficient documentation or failure to demonstrate the absence of complications such as perforation or abscess. Best practices include thorough clinical notes, timely submission of claims, and clear communication with payers regarding the patient's condition 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 K57.33?

K57.33 specifically covers diverticulitis of the large intestine that is characterized by inflammation and bleeding but does not involve perforation or abscess formation. It is important to differentiate this from other types of diverticulitis that may have additional complications.

When should K57.33 be used instead of related codes?

K57.33 should be used when the patient presents with diverticulitis that includes bleeding but lacks perforation or abscess. It is crucial to assess the clinical presentation and any imaging findings to ensure accurate code selection.

What documentation supports K57.33?

Documentation supporting K57.33 should include clinical notes detailing the patient's symptoms, results from imaging studies confirming diverticulitis, and any laboratory tests indicating bleeding or infection. Clear documentation of the absence of perforation or abscess is also essential.