Diverticulosis refers to a condition that occurs when small, bulging pouches (diverticula) develop in the wall of the colon. The condition occurs when one or more of the pouches become inflamed. It causes severe abdominal pain, fever, nausea and a marked change in bowel habits. The condition can occur in mild and severe forms. Treatment of this condition involves a combination of antibiotics and surgery (in severe cases). Incorporating a high-fiber diet and exercise can help prevent the occurrence of this condition in the long run. Gastroenterologists treating patients with this disease have to document the condition and the treatments provided accurately. Gastroenterology medical billing and coding can be challenging. Documentation elements for this gastro-intestinal condition depend on the location as well as any manifestations or complications. For correct clinical documentation of the condition, healthcare practices can rely on the services of medical billing outsourcing companies.
According to reports from the National Institute of Diabetes and Digestive and Kidney Diseases, about 35 percent of US adults aged 50 years or younger have diverticulosis, while about 58 percent of those older than 60 have diverticulosis. Even though there is no single known cause for this condition, several factors such as aging, a low fiber diet, usage of certain medications (like steroids), physical inactivity, obesity and reduced immune function can increase the risk associated with the condition. As diverticulosis doesn’t cause any troublesome symptoms, most people who suffer from diverticulosis are quite unaware that they suffer from this condition. People with this condition experience certain symptoms such as swelling or bloating, abdominal cramps or pain, constipation, tenderness on the affected area, changes in bowel movement patterns, bloating or gas and fever, and general malaise. However, it is important to note that experiencing one or more symptoms doesn’t fully mean that a person has diverticulosis. In fact, these symptoms may depict or relate to other gastrointestinal disorders such as irritable bowel syndrome, celiac disease, inflammatory bowel disease, appendicitis, gallstones and stomach ulcers.
ICD-10 Diagnosis Codes to Report Diverticulosis
Diagnosis of diverticulosis involves a medical history review, physical examination, blood tests and evaluation of symptoms to analyze bowel movements and check the abdomen for pain and tenderness. Diagnosis may be confirmed by performing a CT scan, an X-ray, or a colonoscopy. If the gastroenterologist suspects that a person may have diverticulitis, he/she may request additional tests. The physician documentation in the medical record determines the coding and sequencing for diverticulosis. In ICD-10-CM, diverticular disease of intestine or diverticulitis is coded to K57. The codes include location (small, large or small and large intestine), with or without perforation or abscess, and with or without bleeding.
- K57 Diverticular disease of intestine
- K57.0 Diverticulitis of small intestine with perforation and abscess
- K57.00 …… without bleeding
- K57.01 …… with bleeding
- K57.1 Diverticular disease of small intestine without perforation or abscess
- K57.10 Diverticulosis of small intestine without perforation or abscess without bleeding
- K57.11 Diverticulosis of small intestine without perforation or 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
- K57.2 Diverticulitis of large intestine with perforation and abscess
- K57.20 …… without bleeding
- K57.21 …… with bleeding
- K57.3 Diverticular disease of large intestine without perforation or abscess
- K57.30 Diverticulosis of large intestine without perforation or abscess without bleeding
- K57.31 Diverticulosis of large intestine without perforation or 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
- K57.4 Diverticulitis of both small and large intestine with perforation and abscess
- K57.40 …… without bleeding
- K57.41 …… with bleeding
- K57.5 Diverticular disease of both small and large intestine without perforation or abscess
- K57.50 Diverticulosis of both small and large intestine without perforation or abscess without bleeding
- K57.51 Diverticulosis of both small and large intestine without perforation or abscess with 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
- K57.8 Diverticulitis of intestine, part unspecified, with perforation and abscess
- K57.80 …… without bleeding
- K57.81 …… with bleeding
- K57.9 Diverticular disease of intestine, part unspecified, without perforation or abscess
- K57.90 Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding
- K57.91 Diverticulosis of intestine, part unspecified, without perforation or 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
Treatment for Diverticulosis
Most people with diverticulosis without symptoms do not require any specific treatment. Mild forms are treated with antibiotic medications. On the other hand, if diverticulosis is severe enough, surgery may be performed to remove the affected areas of the colon (bowel resection/ colectomy). During this surgery, the surgeon removes the diseased parts of the bowel and then reconnects the healthy parts. The surgeon may remove all or part of the bowel.
To assign the correct codes, experienced medical coders carefully examine the operative reports to determine what procedure or procedures the surgeon performed. CPT codes for colectomy are as follows –
Traditional Open Procedure
- 44140 Colectomy, partial; with anastomosis
- 44141 Colectomy, partial; with skin level cecostomy or colostomy
- 44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
- 44144 Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula
- 44145 Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
- 44146 Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy
- 44147 Colectomy, partial; abdominal and transanal approach
- 44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy
- 44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy
- 44155 Colectomy, total, abdominal, with proctectomy; with ileostomy
- 44156 Colectomy, total, abdominal, with proctectomy; with continent ileostom
- 44157 Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed
- 44160 Colectomy, partial, with removal of terminal ileum with ileocolostomy
Laparoscopic Procedure
- 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis
- 44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy
- 44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
- 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
- 44208 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy
- 44210 Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy
- 44211 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed
- 44212 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy
- 44213 Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (to be listed separately in addition to primary procedure
Gastroenterology medical coding can be quite challenging for gastroenterologists and their physician team. Outsourcing billing and coding tasks to a medical billing company is a practical option for physicians to ensure accurate clinical documentation and avoid claim denials.
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