ICD-10 Coding for Pelvic Abscess(K65.1, K57.20)
Complete ICD-10-CM coding and documentation guide for Pelvic Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pelvic Abscess
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K65.1 | Peritoneal abscess | Use when a pelvic abscess is confirmed by imaging and/or culture. |
|
| K57.20 | Diverticulitis of large intestine with perforation and abscess without bleeding | Use when diverticulitis is complicated by a pelvic abscess. |
|
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 pelvic abscess
Essential facts and insights about Pelvic Abscess
Primary ICD-10-CM Codes for pelvic abscess
Decision Criteria
clinical Criteria
- Presence of pelvic abscess confirmed by imaging
documentation Criteria
- Detailed procedure note including abscess size and location
Applicable To
- Abdominopelvic abscess
Excludes
- Retroperitoneal abscess (K68.11)
Clinical Validation Requirements
- CT scan showing hypodense collection with rim enhancement
- Positive culture for specific organism
Code-Specific Risks
- Ensure documentation specifies 'pelvic abscess' to avoid misclassification.
Coding Notes
- Ensure imaging and culture results are documented to support the diagnosis.
K57.20 - Diverticulitis of large intestine with perforation and abscess without bleeding
Use when diverticulitis is complicated by a pelvic abscess.
Applicable To
- Diverticulitis with pelvic abscess
Excludes
- Diverticulitis without abscess (K57.30)
Clinical Validation Requirements
- CT scan showing diverticular disease with associated abscess
- Clinical correlation with diverticulitis symptoms
Coding Notes
Ensure both diverticulitis and abscess are documented for accurate coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pelvic and perineal pain
R10.2Differential 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 Pelvic Abscess to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K65.1.
Impact
Clinical: May lead to incorrect treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Ensure detailed imaging and culture documentation., Use standardized templates for procedure notes.
Impact
Reimbursement: Potential loss of MCC-related reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of patient severity.
Mitigation Strategy
Always add K65.1 when a pelvic abscess is present to capture MCC.
Impact
Reimbursement: Incorrect procedure coding affects payment., Compliance: Non-compliance with procedural coding standards., Data Quality: Misrepresentation of surgical intervention.
Mitigation Strategy
Use 49020 or 45000 for deep pelvic abscesses.
Impact
Failure to document MCC status can lead to audit findings.
Mitigation Strategy
Ensure all MCC-related documentation is complete and accurate.
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 Pelvic Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pelvic Abscess
Use these documentation templates to ensure complete and accurate documentation for Pelvic Abscess. These templates include all required elements for proper coding and billing.
Post-operative pelvic abscess
Specialty: SurgeryRequired Elements
- Abscess size and location
- Imaging modality
- Culture results
- Surgical approach
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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