General Surgery Coding Alert

Question: We have an op report from a colonoscopy in which the surgeon diagnosed diverticulosis. I'm trying to find the correct diagnosis code for the claim, but I'm confused about the difference between diverticulosis and diverticulitis. Could you clarify coding for these conditions?

Illinois Subscriber

Answer: For a diverticulosis diagnosis during a colonoscopy, you should report the appropriate code such as K57.30 (Diverticulosis of large intestine without perforation or abscess without bleeding). If the op report notes comorbid conditions such as perforation or abscess, you would need to pick a different appropriate code.

Regarding the distinction between diverticulosis and diverticulitis, here's an explanation:

Diverticulosis 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 (such as K57.31, Diverticulosis of large intestine without perforation or abscess with bleeding).

Patients with diverticulitis (such as K57.92, Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding) often have abdominal pain and fever. Many of these patients respond to treatments such as temporary liquid or very low-fiber diets, and antibiotics. If something in the E/M service or CAT scan indicates abscess or perforation or both, other ICD-10 codes pertain.

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.

Remember: Until your surgeon diagnoses diverticulosis or diverticulitis, you should report only the signs and symptoms.