Dig Into Diverticulitis Treatment and Coding Guidelines
Look for bleeding, perforation, or abscess in the notes. Diverticulitis is a painful condition that can require invasive treatments for the most severe cases. Determining the correct ICD-10-CM code for a diverticulitis diagnosis requires careful review of the gastroenterologist’s medical report. Read on to learn about this condition and understand how to identify the correct diagnosis codes for your claim. Get to Know Diverticulitis and Common Treatments Diverticulitis is inflammation of irregularly bulging pouches in the large intestine wall. Normally, the wall of the intestine (colon) is smooth. When a pouch forms on the colon wall it is called a diverticulum (multiple pouches are called diverticula). This condition is common after age 50 and is typically found in the lower part of the colon. In most situations, these diverticula do not cause issues. The presence of diverticula is also called diverticulosis, but this is not considered the disease condition. It is only when the pouches become inflamed that it is called diverticulitis. Inflammation in the colon is the immune system increasing blood flow and providing fluids to a site to deliver disease-fighting cells. When inflammation occurs in the diverticula, patients can experience pain, fever, nausea, and changes in stool habits. When the diverticulitis is mild, it can be treated with rest, changes in diet, and antibiotics, when needed. In cases of severe or recurrent diverticulitis, surgery may be necessary. When diverticulitis is severe enough for surgery, the physician performs the procedure via two approaches — laparoscopic or open. The provider removes the diseased section of the colon and the healthy tissues are connected to recreate a complete colon. Another option for surgery is to separate the diseased section of the colon, and then connect the healthy tissue to an opening in the abdomen wall (stoma). Waste is then collected in a colostomy bag. This approach gives the colon time to heal before reconnection to make a complete colon. Other procedures are available that may be necessary to treat complications such as peritonitis or fistulas. Hospitalization should be considered when patients have signs of peritonitis, as inpatient management can include intravenous (IV) resuscitation and IV antibiotics as appropriate. Laparoscopic surgery can result in shorter hospital stays, fewer complications, and reduced in-hospital mortality rates compared to open colectomy. Recognize the Symptoms and Risk Factors One of the most common symptoms that occur with diverticulitis is abdominal pain, more specifically located in the lower left abdomen. This pain could be sudden onset and intense, starting off mild and getting worse over time. Additional symptoms associated with diverticulitis include: As previously stated, this condition occurs most frequently in older adults and is believed to be caused by spasms or straining, which can cause the diverticula to form in areas where the colon is weak. Diverticulitis can also be caused by bacterial disease or damage to the diverticula tissue. Per the National Health Service (NHS), diverticulitis may also cause rectal bleeding or mucus. If either of these symptoms occur, patients are advised to seek medical attention. A patient’s genetics could also play a role in diverticulitis. Patients with the following factors are at an increased risk of diverticulitis: Providers use blood tests, stool tests, MRI, CT, ultrasounds, and colonoscopies to diagnosis diverticulitis. In some rare instances, diverticulitis can be incorrectly diagnosed as colon cancer. Differential diagnoses for patients who present with acute diverticulitis include appendicitis, bowel obstruction, inflammatory bowel disease, irritable bowel disease, and nephrolithiasis. Healthcare providers recommend that when a patient experiencing diverticulitis hasn’t undergone a recent colonoscopy, one should be performed six to eight weeks after the diverticulitis episode clears up. Some complications such as abscesses, fistula, internal obstructions, or intestinal perforations might occur with rectal bleeding. When this occurs, the physician will recommend a blood transfusion, colonoscopy, angiogram with medications, or surgery to resolve the bleeding. Review Diverticulitis Coding Guidelines The ICD-10-CM code book includes numerous different diagnosis codes for you to assign for diverticulitis depending on the part of the intestine involved, whether the condition is with perforation, abscess, and with or without bleeding. The most common diverticulitis diagnosis codes include: Note: Emphasis added to the descriptors above. Aside from the diagnosis codes listed above, there are also diverticulitis codes of both the small and small/large intestine, with and without bleeding/perforation/abscess. The code book also contains other and unspecified diverticulitis diagnosis codes. Coders should carefully examine the evaluation and management (E/M) notes and operative reports to assign the correct codes. Diverticulitis can also be classified as uncomplicated or complicated. Uncomplicated diverticulitis is typically localized diverticular inflammation; with complicated diverticulitis, symptoms can also include abscess, phlegmon, fistula, obstruction, bleeding, or perforation. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
