ICD-10 Coding for Perforated Diverticulitis(K57.20, K57.21)
Complete ICD-10-CM coding and documentation guide for Perforated Diverticulitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Perforated Diverticulitis
K57.20-K57.41Primary Range
Diverticulitis of intestine with perforation and abscess
This range includes codes for diverticulitis with perforation and/or abscess, specifying the intestine involved.
Intra-abdominal abscess
Used as an ancillary code when an abscess extends beyond the bowel wall.
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 imaging confirms perforation and abscess in the large intestine without bleeding. |
|
| K57.21 | Diverticulitis of large intestine with perforation and abscess with bleeding | Use when there is documented bleeding alongside perforation and 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 perforated diverticulitis
Essential facts and insights about Perforated Diverticulitis
Primary ICD-10-CM Codes for perforated diverticulitis
Decision Criteria
clinical Criteria
- CT findings of perforation and abscess
documentation Criteria
- Explicit mention of perforation and abscess in clinical notes
Applicable To
- Perforated diverticulitis of sigmoid colon
Excludes
- Diverticulitis without perforation (K57.32)
Clinical Validation Requirements
- CT showing colonic wall thickening, extraluminal air, and abscess
- CRP >170 mg/L
Code-Specific Risks
- Incorrectly coding without confirming perforation and abscess
Coding Notes
- Ensure documentation specifies perforation and abscess to avoid incorrect coding.
K57.21 - Diverticulitis of large intestine with perforation and abscess with bleeding
Use when there is documented bleeding alongside perforation and abscess.
Applicable To
- Perforated diverticulitis with bleeding
Excludes
- Diverticulitis without bleeding (K57.20)
Clinical Validation Requirements
- CT showing perforation, abscess, and evidence of bleeding
- Drop in hemoglobin ≥2 g/dL
Coding Notes
Ensure bleeding is documented to use this code.
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 Perforated Diverticulitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K57.20.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement.
Mitigation Strategy
Educate clinicians on documentation standards, Use templates for consistency
Impact
Reimbursement: Potential underpayment due to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data.
Mitigation Strategy
Ensure the specific location is documented and coded correctly.
Impact
Lack of detail in documentation can lead to audit discrepancies.
Mitigation Strategy
Implement detailed documentation templates.
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 Perforated Diverticulitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Perforated Diverticulitis
Use these documentation templates to ensure complete and accurate documentation for Perforated Diverticulitis. These templates include all required elements for proper coding and billing.
Post-Operative Documentation
Specialty: SurgeryRequired Elements
- Operative findings
- Perforation details
- Abscess description
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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