ICD-10-CM provides more than 20 codes for diverticular disease of the intestine, so you know attention to detail is the key to success! Here are five areas to watch to improve your coding accuracy.
1. Eat Your Wheaties Before You Tackle Documentation
ICD-10-CM includes a lot of codes for diverticular disease under K57.-, so you’ve got to be ready to spend some energy on analyzing the documentation to choose the correct code. (And in case “eat your Wheaties” isn’t in your vocabulary, it means power up before you take on a challenge!)
Here are the main pointers to check for to choose among the K57.- codes.
- Diverticulosis (the presence of diverticula, or pouches, without inflammation in the wall of the intestine)
- Diverticulitis (inflammation of a diverticulum, which may undergo perforation with abscess formation)
- Small intestine
- Large intestine
- Both small and large intestine
- Any Complications Present?
2. Capture Additional Code for Peritonitis
At the category level, K57.- has a note to “Code also if applicable peritonitis K65.-.” Be sure to apply this note to all the codes in the K57.- category.
3. Apply 2 Levels of Excludes Notes
For these diagnoses, you’ll find Excludes notes at both the category level and, in some cases, at the subcategory level.
At the Category level, there’s an Excludes1 note pointing you to Q43.8 for congenital diverticulum of intestine and Q43.0 for Meckel’s diverticulum.
There is also an Excludes2 note pointing you to K38.2 for diverticulum of appendix.
The Excludes1 notes at the subcategory level make sure you remember that ICD-10-CM provides codes specific to cases where the patient has both small and large intestine diverticular disease:
- K57.0-, Excludes1: diverticulitis of both small and large intestine with perforation and abscess (K57.4-)
- K57.1-, Excludes 1: diverticular disease of both small and large intestine without perforation or abscess (K57.5-)
- K57.2-, Excludes1: diverticulitis of both small and large intestine with perforation and abscess (K57.4-)
- K57.3-, Excludes1: diverticular disease of both small and large intestine without perforation or abscess (K57.5-).
4. Know Where to Go for NOS
When documentation doesn’t offer every tidbit from tip 1, ICD-10-CM offers you guidance on which codes are appropriate for NOS (not otherwise specified) diagnoses. Notes with the codes in the ICD-10-CM Tabular provide this list. (And of course you can always check for default codes in the Index.)
- Diverticular disease of small intestine NOS: K57.10 (Diverticulosis of small intestine without perforation or abscess without bleeding)
- Diverticular disease of colon NOS: K57.30 (Diverticulosis of large intestine without perforation or abscess without bleeding)
- Diverticular disease of both small and large intestine NOS: K57.50 (Diverticulosis of both small and large intestine without perforation or abscess without bleeding)
- Diverticulitis of intestine NOS with peritonitis: Subcategory K57.8- (Diverticulitis of intestine, part unspecified, with perforation and abscess)
- Diverticular disease of intestine NOS: K57.90 (Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding)
5. Avoid This Skimming Mistake
Some of the K57.- subcategories specify “diverticulitis” while others include the term “diverticular disease.” But don’t skip the subcategories for diverticular disease if you’re coding diverticulitis. Those subcategories may include codes for both diverticulosis and diverticulitis. For instance, K57.3- (Diverticular disease of large intestine without perforation or abscess) includes diverticulosis codes like K57.31 (Diverticulosis of large intestine without perforation or abscess with bleeding) and diverticulitis codes like K57.33 (Diverticulitis of large intestine without perforation or abscess with bleeding).
What About You?
What’s your approach to getting adequate documentation for diagnoses like these with specific ICD-10-CM requirements?