Gastroenterology Coding Alert

Hint: Choose from another additional four codes if anatomical location is not specified.

When your clinician diagnoses diverticulitis, choose the right ICD-10 codes based on anatomical location and hemorrhage as you did with ICD-9, while also factoring in the presence or absence of perforation and abscess.

ICD-9: When reporting a diagnosis of diverticulitis, you’ll currently have to report from four codes depending on the location and the presence or absence of bleeding (or hemorrhage). So, you’ll report diverticulitis diagnosis using these four codes:

• 562.01 (Diverticulitis of small intestine [without hemorrhage])
  
• 562.03 (Diverticulitis of small intestine with hemorrhage)
  
• 562.11 (Diverticulitis of colon [without hemorrhage])
  
• 562.13 (Diverticulitis of colon with hemorrhage)
  

Caveat: You would not use these above mentioned codes if your clinician is able to confirm that the diagnosis is congenital diverticulum of colon (751.5); diverticulum of appendix (543.9) or Meckel’s diverticulum (751.0). Also, it is necessary to note that any associated peritonitis should be identified by using an additional code from the range 567.0-567.9.

Note: When using ICD-9 codes to report a diagnosis of diverticulitis that your clinician identifies in both the small intestine and the colon, you’ll have to use the individual codes for both the locations (depending on the presence or absence of hemorrhage) and report them appropriately.

ICD-10: When you begin using ICD-10 codes, reporting a diagnosis of diverticulitis will still follow same guidelines as that of anatomical location and presence or absence of bleeding. But, in ICD-10, you have two more codes that help you report a diagnosis of diverticulitis if it is present in both the small intestine and the large intestine.

Also, the descriptor to these ICD-10 codes also includes the term “without perforation and abscess” or “with perforation and abscess” in addition to the location and bleeding parameters to help in distinguishing these codes sets and providing you additional options of reporting the diagnosis very specifically.

So, the 12 codes that you have to report a diagnosis of diverticulitis include:

• K57.00 (Diverticulitis of small intestine with perforation and abscess without bleeding)
• K57.01 (Diverticulitis of small intestine with perforation and abscess with bleeding)
• K57.12 (Diverticulitis of small intestine without perforation or abscess without bleeding)
• K57.13 (Diverticulitis of small intestine without perforation or abscess with bleeding)
• K57.20 (Diverticulitis of large intestine with perforation and abscess without bleeding)
• K57.21 (Diverticulitis of large intestine with perforation and abscess with bleeding)
• K57.32 (Diverticulitis of large intestine without perforation or abscess without bleeding)
• K57.33 (Diverticulitis of large intestine without perforation or abscess with bleeding)
• K57.40 (Diverticulitis of small and large intestine with perforation and abscess without bleeding)
• K57.41 (Diverticulitis of small and large intestine with perforation and abscess without bleeding)
• K57.52 (Diverticulitis of both small and large intestine without perforation or abscess without bleeding)
• K57.53 (Diverticulitis of both small and large intestine without perforation or abscess with bleeding)

Reminder: As in ICD-9, you should use the more specific ICD-10 codes if your clinician is able to confirm that the diagnosis is congenital diverticulum of small intestine (Q43.8); Meckel’s diverticulum (Q43.0) or diverticulum of the appendix (K38.2).

Note: If the anatomical location of the diverticulitis cannot be completelyspecified, you have to report from four more code choices:

• K57.80 (Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding)
• K57.81 (Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding)
• K57.92 (Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding)
• K57.93 (Diverticulitis of intestine, part unspecified, without perforation or abscess with bleeding)

Check These Basics Briefly

Documentation spotlight: Some symptoms that you are most likely to encounter in the documentation of a patient suffering from diverticulitis includes abdominal pain most often in the lower left quadrant; bloating; nausea; vomiting; constipation; change in bowel habits; flatulence; fever and fatigue.

Upon examination, your clinician might note signs of tenderness on palpating the lower abdominal area, a palpable tender mass, signs of weight loss, and signs of anemia.

Tests: While in most of the cases, your clinician will be able to clinch the diagnosis based on history, signs and symptoms, lab tests will help in ascertaining the diagnosis. Some of the tests that your clinician might order include a complete blood count (CBC); liver function tests; blood culture and urinalysis. Some of these tests will help your clinician eliminate other diagnosis that could be resulting in similar signs and symptoms.

Apart from these lab tests, your gastroenterologist may also order imaging studies such as an abdominal x-ray or a CT scan. Apart from these imaging studies and depending on clinical circumstances (endoscopic studies will not be performed in acute cases) your clinician may also perform endoscopic studies such as an upper GI endoscopy or a small intestine endoscopy. If he is suspecting diverticulitis of the colon, he may perform a colonoscopy but usually at a later date.

Based on the history, symptoms, examination, lab and diagnostic tests, your clinician will arrive at the diagnosis of diverticulitis.

Example: Your gastroenterologist recently reviewed a 63-year-old female patient with complaints of increasing abdominal pain with bloating. She says that she has also been suffering from some episodes of nausea, vomiting and diarrhea from the past few days.

Your clinician records a complete history of the patient and examines the patient and notes left lower quadrant abdominal tenderness with no palpable mass. Your clinician also documents that the patient has fever and has pale sclera.

Your clinician drew a blood sample and obtained a urine sample and these were sent to the lab for analysis. He also ordered an abdominal CT scan which revealed colonic diverticula and pericolic stranding of fat. This finding made him suspect diverticulitis of the large intestine. He prescribed antibiotics for several days and the patient improved but still had some change in bowel habits for the following few weeks. He then performed a colonoscopy that confirmed a diagnosis of diverticulitis of the colon without bleeding, perforation or abscess.

What to report: You report the office visit with 99204 (Office or other outpatient visit for the evaluation and management of a new patient…) and report 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the colonoscopy procedure that was performed by your gastroenterologist.

You report the diagnosis with K57.32 if you are using ICD-10 codes or use 562.11 if reporting using ICD-9 codes.