ICD-10 Coding for Diverticulitis with Perforation(K57.20, K57.21)
Complete ICD-10-CM coding and documentation guide for Diverticulitis with Perforation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diverticulitis with Perforation
K57.2-K57.9Primary Range
Diverticular disease of intestine
This range includes codes for diverticulitis with and without perforation, abscess, and bleeding.
Peritonitis
Includes codes for peritonitis which may be used in conjunction with diverticulitis codes when applicable.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K57.20 | Diverticulitis of large intestine with perforation and abscess without bleeding | Use when diverticulitis of the large intestine is confirmed with perforation and abscess, but without bleeding. |
|
| K57.21 | Diverticulitis of large intestine with perforation and abscess with bleeding | Use when diverticulitis of the large intestine is confirmed with perforation, abscess, and bleeding. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for diverticulitis with perforation
Essential facts and insights about Diverticulitis with Perforation
Primary ICD-10-CM Codes for diverticulitis with perforation
Decision Criteria
clinical Criteria
- CT scan confirms perforation and abscess without bleeding.
documentation Criteria
- Absence of bleeding must be clearly documented.
Applicable To
- Diverticulitis with perforation
- Diverticulitis with abscess
Excludes
- Diverticulitis with bleeding (K57.21)
Clinical Validation Requirements
- CT scan showing extraluminal air
- Pericolic abscess on imaging
Code-Specific Risks
- Misidentifying the presence of bleeding
- Failing to document abscess
Coding Notes
- Ensure documentation specifies the absence of bleeding to use K57.20.
K57.21 - Diverticulitis of large intestine with perforation and abscess with bleeding
Use when diverticulitis of the large intestine is confirmed with perforation, abscess, and bleeding.
Applicable To
- Diverticulitis with perforation and bleeding
Excludes
- Diverticulitis without bleeding (K57.20)
Clinical Validation Requirements
- Endoscopy showing active bleeding
- Drop in hemoglobin levels
Coding Notes
Ensure bleeding is documented to use K57.21.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Intra-abdominal abscess
K65.1Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diverticulitis with Perforation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K57.20.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect reimbursement.
Mitigation Strategy
Ensure bleeding status is assessed and documented in all cases., Use standardized templates for documentation.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Use K57.20 or K57.21 based on the presence of bleeding and specific location.
Impact
Failure to document abscess size and location can lead to audit issues.
Mitigation Strategy
Use imaging reports to confirm and document abscess details.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Diverticulitis with Perforation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diverticulitis with Perforation
Use these documentation templates to ensure complete and accurate documentation for Diverticulitis with Perforation. These templates include all required elements for proper coding and billing.
Acute Diverticulitis with Perforation
Specialty: GastroenterologyRequired Elements
- CT imaging results
- Presence of abscess
- Bleeding status
- Operative findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Diverticulitis with Perforation? Ask your questions below.