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ICD-10 Guide
ICD-10 CodesK57.41

K57.41

Billable

Diverticulitis of both small and large intestine with perforation and abscess with bleeding

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

Code Description

ICD-10 K57.41 is a billable code used to indicate a diagnosis of diverticulitis of both small and large intestine with perforation and abscess with bleeding.

Key Diagnostic Point:

K57.41 refers to diverticulitis of both the small and large intestine characterized by perforation and abscess formation accompanied by bleeding. Diverticulitis occurs when diverticula, small pouches that can form in the lining of the digestive system, become inflamed or infected. This condition can lead to severe complications, including perforation of the intestinal wall, which can result in peritonitis, a serious abdominal infection. The clinical presentation may include abdominal pain, fever, nausea, vomiting, and changes in bowel habits. The anatomy involved primarily includes the colon, but in this case, both the small intestine and large intestine are affected. Disease progression can lead to abscess formation, which may require surgical intervention. Diagnostic considerations include imaging studies such as CT scans to confirm the presence of diverticula, inflammation, abscesses, or perforation. Laboratory tests may also be performed to assess for infection and bleeding. Prompt diagnosis and treatment are critical to prevent further complications and ensure patient safety.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying diverticulitis severity.
  • Documentation gaps may arise if the clinical details of perforation and abscess are not clearly stated.
  • Billing challenges can occur if the complexity of the case is not adequately reflected in the documentation.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K57.41 is profound, as it represents a severe form of diverticulitis that can lead to significant morbidity and mortality if not treated promptly. The population health impact includes increased healthcare utilization due to hospital admissions and potential surgical interventions. Quality measures may focus on timely diagnosis and management of diverticulitis complications, while epidemiological considerations highlight the rising prevalence of diverticular disease in aging populations.

ICD-9 vs ICD-10

The clinical significance of K57.41 is profound, as it represents a severe form of diverticulitis that can lead to significant morbidity and mortality if not treated promptly. The population health impact includes increased healthcare utilization due to hospital admissions and potential surgical interventions. Quality measures may focus on timely diagnosis and management of diverticulitis complications, while epidemiological considerations highlight the rising prevalence of diverticular disease in aging populations.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided, particularly if surgical intervention is necessary. Common denials may arise from insufficient documentation of the complications associated with diverticulitis. Best practices include thorough clinical notes, imaging reports, and laboratory results that substantiate the diagnosis and treatment plan, ensuring compliance with payer requirements.

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 K57.41?

K57.41 covers diverticulitis of both the small and large intestines that is complicated by perforation, abscess formation, and associated bleeding. This code is used when these specific complications are present, differentiating it from less severe forms of diverticulitis.

When should K57.41 be used instead of related codes?

K57.41 should be used when there is clear documentation of diverticulitis with perforation and abscess, along with evidence of bleeding. If the diverticulitis is uncomplicated or lacks these complications, other codes such as K57.30 should be considered.

What documentation supports K57.41?

Documentation for K57.41 should include clinical notes detailing the diagnosis of diverticulitis, imaging results showing perforation and abscess, laboratory findings indicating bleeding, and any surgical notes if applicable. Comprehensive documentation is essential to support the complexity of the case.