Gastroenterology Coding Alert

Question: I'm new to gastroenterology coding, and I'm wondering what the difference is between diverticulosis and diverticulitis. How should I code these conditions?


California Subscriber

Answer: Diverticulosis (562.10, Diverticulosis of colon [without mention of hemorrhage]) occurs when 3 mm-3 cm "diverticula" or pockets poke out from the colon's muscle wall. This happens most often in the sigmoid colon where there is the most pressure and is most common in people 40 years of age or older. Other risk factors are low-fiber diets, constipation and dehydration.

As many as 80 percent of people with diverticulosis don't know they have it, and physicians sometimes discover it while they are performing diagnostic tests related to other GI signs and symptoms.

Diverticulosis becomes more problematic when small perforations occur within the pockets so that they become infected and inflamed, creating diverticulitis. Because the small blood vessels at the edge of the diverticuli are fragile, another common problem is bleeding (562.11, Diverticulitis of colon [without mention of hemorrhage]; 562.12, Diverticulosis of colon with hemorrhage; or 562.13, Diverticulitis of colon with hemorrhage).

Patients with diverticulitis have abdominal pain and fever. About 80 percent of these patients respond to treatments such as temporary liquid or very low-fiber diets, antibiotics, and CT-guided percutaneous drainage.

Bleeding from diverticulosis can be very severe, often requiring emergency procedures to stop the bleeding. Fortunately, the bleeding usually stops spontaneously. Some patients, however, require colon resection surgery.

Note: Diverticulosis and diverticulitis also occur, although less often, in the small intestine (562.0x). Diverticula occur even less often (and asymptomatically most of the time) in the duodenum.

Remember: Until your gastroenterologist diagnoses diverticulosis or diverticulitis, you should report only the signs and symptoms. Look at your gastroenterologist's notes for clarification.