K57.92

Diverticulitis of colon, part unspecified, without perforation or abscess without bleeding

Diverticulitis of the colon (part unspecified) without perforation, abscess, or hemorrhage is a condition characterized by the inflammation of pre-existing diverticula—small, bulging pouches that form in the colonic wall. In this specific classification, the inflammation is localized to the colon but the exact segment (e.g., sigmoid or descending colon) is not documented, and the clinical presentation is categorized as uncomplicated. This means there is no evidence of macro-perforation (free air), localized collection of pus (abscess), or associated lower gastrointestinal bleeding. The pathophysiology usually involves the obstruction of a diverticular neck by a fecalith or inspissated food particles, leading to increased intraluminal pressure, localized ischemia, and subsequent bacterial overgrowth or micro-perforation that triggers an inflammatory response in the pericolic fat.

Clinical Symptoms

  • Constant, localized abdominal pain (most commonly in the left lower quadrant)
  • Abdominal tenderness upon palpation
  • Low-grade fever
  • Nausea and vomiting
  • Change in bowel habits (constipation is more common than diarrhea)
  • Abdominal bloating or distension
  • Anorexia (loss of appetite)
  • Leukocytosis (elevated white blood cell count)
  • Possible urinary frequency or urgency if the bladder is irritated by adjacent inflammation

Common Causes

  • Inflammation of pre-existing diverticula (diverticulosis)
  • Low-fiber diet, which increases colonic pressure and transit time
  • Obesity and high visceral fat
  • Physical inactivity
  • Smoking
  • Chronic use of certain medications including NSAIDs, steroids, and opioids
  • Genetic predisposition to connective tissue weakness in the colonic wall
  • Alterations in the gut microbiome (dysbiosis)

Documentation & Coding Tips

Distinguish between diverticulosis and diverticulitis to ensure correct acuity coding.

Example: Patient presents with persistent left lower quadrant pain and fever. CT imaging confirms acute diverticulitis of the sigmoid colon. There is no evidence of bowel wall perforation or localized abscess. Patient has a history of chronic diverticulosis. Billing Focus: Coding for diverticulitis (K57.92) rather than diverticulosis (K57.90) is necessary for high-acuity management. Risk Adjustment: Acute diverticulitis represents a higher clinical complexity than asymptomatic diverticulosis.

Billing Focus: Acuity (Acute vs Chronic)

Explicitly document the absence of perforation, abscess, and fistula in the clinical record.

Example: Evaluation of abdominal pain today reveals diverticulitis of the colon. Clinical and radiological findings specifically exclude perforation, fistula, or abscess formation. No free air or fluid collections identified. Billing Focus: Verifying the absence of complications supports the selection of K57.92. Risk Adjustment: Complicated diverticulitis codes map to higher-weighted HCC categories compared to K57.92.

Billing Focus: Complication status

Clearly document the presence or absence of gastrointestinal bleeding or hemorrhage.

Example: Patient diagnosed with diverticulitis of the colon. Patient denies hematochezia or melena. Rectal exam is guaiac negative. Vital signs are stable without evidence of hemodynamic compromise. Billing Focus: The without bleeding descriptor in K57.92 requires explicit documentation of the absence of hemorrhage. Risk Adjustment: Co-occurring bleeding significantly increases medical risk and management complexity.

Billing Focus: Hemorrhage status

Specify the anatomical location of the diverticulitis to move from unspecified to specific codes.

Example: CT abdomen reveals acute diverticulitis localized to the descending colon. No abscess or perforation noted. Clinical management initiated with oral antibiotics. Billing Focus: While K57.92 is for unspecified parts, documenting the descending colon allows for more specific coding (K57.32). Risk Adjustment: Anatomic specificity reduces audit risk and improves data accuracy for longitudinal care.

Billing Focus: Anatomic specificity

Incorporate comorbid conditions that impact the management of diverticulitis.

Example: The patient is a 65-year-old with acute diverticulitis of the colon. Plan includes bowel rest and antibiotics. Note also addresses the patient's Type 2 Diabetes Mellitus with hyperglycemia (E11.65), which may complicate the inflammatory response. Billing Focus: Linking comorbidities to the treatment plan supports medical necessity for higher-level E/M services. Risk Adjustment: Comorbidities like Diabetes Mellitus significantly increase the patient's overall risk score.

Billing Focus: Medical necessity for complexity

Relevant CPT Codes

Related Diagnoses

Hierarchy