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ICD-10 Guide
ICD-10 CodesK57.93

K57.93

Billable

Diverticulitis of intestine, part unspecified, without perforation or abscess with bleeding

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

Code Description

ICD-10 K57.93 is a billable code used to indicate a diagnosis of diverticulitis of intestine, part unspecified, without perforation or abscess with bleeding.

Key Diagnostic Point:

K57.93 refers to diverticulitis of the intestine, part unspecified, without perforation or abscess, accompanied by bleeding. Diverticulitis occurs when diverticula, small bulging pouches that can form in the lining of the digestive system, become inflamed or infected. This condition typically presents with symptoms such as abdominal pain, fever, and changes in bowel habits, including diarrhea or constipation. The anatomy involved primarily includes the colon, where diverticula are most commonly located. Disease progression can vary; in mild cases, symptoms may resolve with conservative management, while severe cases may lead to complications such as perforation or abscess formation, which are not present in this code. Diagnostic considerations include a thorough clinical evaluation, imaging studies like CT scans, and laboratory tests to assess for infection or bleeding. The absence of perforation or abscess is crucial for the accurate application of this code, as these complications would necessitate different coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors include misclassification of diverticulitis severity.
  • Documentation gaps may arise if clinical notes do not clearly indicate the absence of perforation or abscess.
  • Billing challenges can occur if the bleeding is not adequately documented or if the treatment plan is not aligned with 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 in its uncomplicated form, has significant clinical implications, affecting a large segment of the population, especially older adults. It can lead to increased healthcare utilization, including emergency visits and hospital admissions. Understanding the epidemiology of diverticulitis helps in developing quality measures and preventive strategies, ultimately improving patient outcomes and reducing healthcare costs.

ICD-9 vs ICD-10

Diverticulitis, particularly in its uncomplicated form, has significant clinical implications, affecting a large segment of the population, especially older adults. It can lead to increased healthcare utilization, including emergency visits and hospital admissions. Understanding the epidemiology of diverticulitis helps in developing quality measures and preventive strategies, ultimately improving patient outcomes and reducing healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the treatment provided. Common denials may arise from insufficient documentation of bleeding or failure to specify the absence of complications. Best practices include ensuring that clinical notes are comprehensive and that all relevant tests and treatments are documented to support the diagnosis and justify the billed services.

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 K57.93?

K57.93 covers diverticulitis of the intestine 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.

When should K57.93 be used instead of related codes?

K57.93 should be used when the patient presents with diverticulitis characterized by inflammation and bleeding, but without any signs of perforation or abscess. If perforation or abscess is present, other codes such as K57.91 or K57.92 should be utilized.

What documentation supports K57.93?

Documentation should include clinical findings that confirm diverticulitis, evidence of bleeding, and explicit notes indicating the absence of perforation or abscess. Imaging results and laboratory tests that support the diagnosis are also essential.