December 22, 2008

Coding for Diverticulosis and Diverticulitis
For The Record
Vol. No. P

Diverticulosis consists of small bulging pouches (diverticula) located in the digestive tract. It develops when naturally weak places in the digestive tract give way under pressure. Diverticula may develop anywhere, including the esophagus, stomach, small intestine and, most commonly, the large intestine. When the diverticula become inflamed or infected, it is called diverticulitis and may occur when bacteria gets trapped in the pouches. The condition can range from minor inflammation to a massive infection.

ICD-9-CM code assignment for diverticulosis includes the following:

• Large intestine — 562.10 (with hemorrhage — 562.12);

• Small intestine — 562.00 (with hemorrhage — 562.02);

• Esophagus — (defaults to congenital) 750.4; acquired esophageal diverticulosis — 530.6; and

• Stomach — 537.1.

Diverticulitis is assigned to the following codes:

• Large intestine — 562.11 (with hemorrhage — 562.13);

• Small intestine — 562.01 (with hemorrhage — 562.03);

• Esophagus — 530.6; and

• Stomach — 537.1.

These code assignments include whether the diverticulosis or diverticulitis was documented as perforated or ruptured. Diverticulosis with diverticulitis is classified only to the code for diverticulitis.

Signs and Symptoms
Diverticulosis usually does not cause signs or symptoms, but if any do occur, they can include abdominal cramping, constipation or diarrhea, and bloating.

Common signs and symptoms of diverticulitis include pain in the lower left side of the abdomen; a severe, sudden onset of pain (however, the pain may also be mild and worsen over several days, fluctuating in intensity); abdominal tenderness, especially when wearing a belt or bending over; fever or chills; bloating or gas; nausea and occasional vomiting; constipation or diarrhea; rectal bleeding; frequent urination; painful or difficult urination; and loss of appetite.

Other conditions may also cause several of these signs and symptoms, such as appendicitis, pelvic inflammatory disease, and irritable bowel syndrome.

Complications
Diverticulitis may lead to several complications, including the following:

• Diverticular bleeding: The diverticula may expand into and erode the surrounding blood vessels. In many circumstances, the bleeding stops on its own. If a patient is admitted with gastrointestinal (GI) bleeding and a colonoscopy identifies the patient has diverticulosis or diverticulitis, the physician must document that the GI hemorrhage/bleed was caused by the diverticulosis or diverticulitis before the code for “with hemorrhage” may be assigned (AHA Coding Clinic for ICD-9-CM, 2005, third quarter, pages 17-18).

• Peritonitis: the spilling of intestinal waste into the abdominal cavity. Tears or perforation can develop in an infected pouch, which can cause an infection within the abdomen.

• Bowel obstruction: blockage of the colon or small intestine.

• Abscess: develops if the infection is limited to the area where the diverticula are inflamed. A patient admitted with colon diverticulitis with abscess is assigned to codes 562.11, Diverticulitis of colon, and 569.5, Abscess of intestine (AHA Coding Clinic for ICD-9-CM, 1996, first quarter, pages 13-14).

• Fistula: abnormal passageway between parts of the intestine and bladder, vagina, or abdominal wall.

Diagnosis
Diverticulosis is typically identified during routine screening exams because it rarely has any detectable symptoms. Diverticulitis may be diagnosed during an acute attack and may be confirmed by a CT scan to visualize the pouches that are inflamed or infected, a barium x-ray (barium enemas) to visualize the colon, or colonoscopy for direct colon visualization.

Treatment
Mild diverticulitis is treated with a liquid or low-fiber diet and antibiotics. Antispasmodic drugs also may be prescribed.

In addition to antibiotics, moderate to severe diverticulitis may be treated with over-the-counter or prescribed pain relievers.

If the diverticulitis is severe enough, surgery may be performed to remove the affected areas of the colon (bowel resection).

Coding and sequencing for diverticulosis and diverticulitis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.