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ICD-10 Guide
ICD-10 CodesK57.50

K57.50

Billable

Diverticulosis of both small and large intestine without perforation or abscess without bleeding

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

Code Description

ICD-10 K57.50 is a billable code used to indicate a diagnosis of diverticulosis of both small and large intestine without perforation or abscess without bleeding.

Key Diagnostic Point:

K57.50 refers to diverticulosis of both the small and large intestine without perforation, abscess, or bleeding. Diverticulosis is characterized by the presence of diverticula, which are small pouches that can form in the walls of the intestines, particularly in the colon. The condition often arises due to increased pressure within the intestinal lumen, leading to the formation of these pouches. Clinically, patients may be asymptomatic or may experience mild abdominal discomfort, bloating, or changes in bowel habits. The disease progression can lead to diverticulitis if the diverticula become inflamed or infected, but in the case of K57.50, there are no signs of such complications. Diagnostic considerations include imaging studies such as CT scans or colonoscopy, which can help visualize the diverticula and rule out other gastrointestinal conditions. It is essential for healthcare providers to monitor patients for any progression of symptoms that may indicate complications, as early intervention can prevent more severe outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires imaging and clinical evaluation.
  • Treatment complexity: Low, typically managed with dietary modifications and monitoring.
  • Documentation requirements: Moderate, necessitating clear documentation of symptoms and diagnostic findings.
  • Coding specificity: High, as it specifically identifies the absence of complications.

Audit Risk Factors

  • Common coding errors: Misclassification of diverticulitis or diverticulosis with complications.
  • Documentation gaps: Incomplete records regarding symptoms or diagnostic imaging.
  • 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 is a prevalent condition, particularly in older adults, and can significantly impact population health due to its association with gastrointestinal complications. Effective management and accurate coding of K57.50 can improve quality measures and healthcare utilization patterns by facilitating appropriate monitoring and intervention strategies. Epidemiologically, understanding the prevalence and management of diverticulosis is crucial for healthcare systems to allocate resources effectively and improve patient outcomes.

ICD-9 vs ICD-10

Diverticulosis is a prevalent condition, particularly in older adults, and can significantly impact population health due to its association with gastrointestinal complications. Effective management and accurate coding of K57.50 can improve quality measures and healthcare utilization patterns by facilitating appropriate monitoring and intervention strategies. Epidemiologically, understanding the prevalence and management of diverticulosis is crucial for healthcare systems to allocate resources effectively and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by appropriate imaging and clinical evaluations. Common denials may arise from insufficient documentation or misclassification of the condition. Coders should ensure that all relevant details are included in the medical record to support the diagnosis and avoid billing challenges. Best practices include regular audits of documentation and coding accuracy to ensure 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 K57.50?

K57.50 covers diverticulosis of both the small and large intestine without any complications such as perforation, abscess, or bleeding. It is important to differentiate it from diverticulitis, which involves inflammation.

When should K57.50 be used instead of related codes?

K57.50 should be used when a patient has diagnosed diverticulosis affecting both the small and large intestines without any complications. If there are signs of inflammation or infection, K57.00 or K57.01 should be considered instead.

What documentation supports K57.50?

Documentation must include a confirmed diagnosis of diverticulosis through imaging studies, a clear description of the absence of complications, and any relevant patient symptoms or history.