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ICD-10 Guide
ICD-10 CodesK57.53

K57.53

Billable

Diverticulitis of both small and large intestine without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.53 is a billable code used to indicate a diagnosis of diverticulitis of both small and large intestine without perforation or abscess with bleeding.

Key Diagnostic Point:

K57.53 refers to diverticulitis affecting both the small and large intestines without perforation or abscess, accompanied by bleeding. This condition arises when diverticula, which are small pouches that can form in the walls of the intestines, become inflamed. The clinical presentation typically includes abdominal pain, particularly in the lower left quadrant, fever, and changes in bowel habits, such as diarrhea or constipation. The anatomy involved includes the small intestine and the colon, where diverticula are commonly located. Disease progression can lead to complications if left untreated, including potential perforation or abscess formation, although these are not present in this specific code. Diagnostic considerations often involve imaging studies such as CT scans, which can help confirm the diagnosis and rule out other conditions. Laboratory tests may also be performed to assess for signs of infection or bleeding. Early diagnosis and management are crucial to prevent further complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K57.53 lies in its potential to lead to serious complications if not managed appropriately. Population health impact includes a growing prevalence of diverticular disease, particularly in older adults, which can lead to increased healthcare utilization and costs. Quality measures focus on timely diagnosis and effective management to prevent complications, thereby improving patient outcomes and reducing hospital admissions.

ICD-9 vs ICD-10

The clinical significance of K57.53 lies in its potential to lead to serious complications if not managed appropriately. Population health impact includes a growing prevalence of diverticular disease, particularly in older adults, which can lead to increased healthcare utilization and costs. Quality measures focus on timely diagnosis and effective management to prevent complications, thereby improving patient outcomes and reducing hospital admissions.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that all relevant clinical information is included in the medical record, as well as coding for any associated procedures performed, such as colonoscopy or imaging studies. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include thorough documentation of symptoms, diagnostic tests, and treatment plans to support the claim.

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 K57.53?

K57.53 covers diverticulitis of both the small and large intestines without perforation or abscess, specifically when there is associated bleeding. It is important to differentiate this from other forms of diverticulitis that may involve complications such as perforation or abscess formation.

When should K57.53 be used instead of related codes?

K57.53 should be used when the clinical scenario involves diverticulitis affecting both intestines without perforation or abscess, and with documented bleeding. It is essential to ensure that the clinical documentation supports the diagnosis and the specific nature of the diverticulitis.

What documentation supports K57.53?

Documentation for K57.53 should include clinical findings such as abdominal pain, imaging results confirming diverticulitis, laboratory tests indicating bleeding, and any treatment plans. Detailed notes on the patient's history and symptoms are also crucial for accurate coding.