Find information on Diverticulitis with Perforation, including clinical documentation, medical coding, and healthcare resources. Learn about Perforated Diverticulitis and Diverticular Disease with Perforation diagnosis, treatment, and management. This resource offers guidance for healthcare professionals on accurate coding and documentation for Diverticulitis with Perforation. Explore relevant medical terminology, symptoms, and clinical presentations associated with this condition.
Also known as
Diverticulitis of large intestine with perforation
Inflammation and perforation of abnormal pouches in the large intestine.
Diverticular disease of intestine
Conditions related to abnormal pouches forming in the intestinal wall.
Paralytic ileus and intestinal obstruction without hernia
Blockage or paralysis of the intestine not due to a hernia.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is there diverticulitis?
Yes
Is there perforation?
No
Do not code diverticulitis. Review medical record for alternative diagnosis.
When to use each related code
| Description |
|---|
| Inflamed colon pouches with rupture. |
| Inflamed colon pouches, no rupture. |
| Colon pouches, no inflammation. |
Coding for diverticulitis with perforation may miss associated abscesses, impacting DRG assignment and reimbursement.
Failing to capture generalized peritonitis complicating perforated diverticulitis leads to underreporting severity.
Insufficient documentation of sepsis arising from perforated diverticulitis can affect quality metrics and reimbursement.
Q: What are the most reliable clinical indicators for differentiating uncomplicated diverticulitis from perforated diverticulitis in the acute setting?
A: Differentiating uncomplicated diverticulitis from perforated diverticulitis requires a combination of clinical findings, laboratory values, and imaging. While localized left lower quadrant pain, fever, and leukocytosis are common in both, perforated diverticulitis often presents with more severe, generalized abdominal pain and signs of peritonitis, such as guarding, rigidity, and rebound tenderness. Hypotension and tachycardia suggesting sepsis can also indicate perforation. Elevated lactate and a significantly higher white blood cell count can further raise suspicion. However, the gold standard for diagnosis remains abdominal CT with contrast, which can visualize free air, extravasated contrast, or abscess formation indicative of perforation. Explore how serial abdominal exams and frequent reassessment of vital signs contribute to early detection of complications. Consider implementing a standardized diagnostic pathway for suspected diverticulitis to ensure timely intervention in cases of perforation.
Q: How does the management of acute perforated diverticulitis differ from that of uncomplicated diverticulitis, and what factors influence the choice between conservative management and surgical intervention?
A: The management of perforated diverticulitis differs significantly from that of uncomplicated diverticulitis. Uncomplicated cases can often be treated with outpatient antibiotics, bowel rest, and close follow-up. However, perforated diverticulitis typically requires hospitalization and intravenous antibiotics covering gram-negative and anaerobic bacteria. The decision between conservative management and surgical intervention depends on the Hinchey classification of the perforation. Patients with Hinchey I or II perforations (localized abscess or phlegmon) might be managed with percutaneous drainage and antibiotics if hemodynamically stable and without generalized peritonitis. However, patients with Hinchey III or IV perforations (purulent or fecal peritonitis) generally require immediate surgical intervention, such as laparoscopic lavage and drainage, resection with primary anastomosis, or Hartmann's procedure. Factors influencing the choice of surgical approach include the patient's overall health, the extent of contamination, and the surgeon's expertise. Learn more about the role of multidisciplinary teams in managing complicated diverticulitis.
Patient presents with acute abdominal pain localized to the left lower quadrant, consistent with diverticulitis. Symptoms include severe tenderness, guarding, and rebound tenderness on palpation. Fever, leukocytosis, and elevated inflammatory markers (CRP, ESR) are noted, suggesting an acute inflammatory process. Imaging studies, including CT abdomen and pelvis with intravenous contrast, reveal evidence of perforated diverticulitis, demonstrating extraluminal air and/or fluid collection consistent with an abscess. The patient's clinical presentation and imaging findings meet the diagnostic criteria for complicated diverticulitis with perforation. Differential diagnoses considered include appendicitis, bowel obstruction, and inflammatory bowel disease. Given the severity of the perforation, surgical consultation is obtained. Treatment plan includes bowel rest, intravenous fluids, broad-spectrum antibiotics to cover gram-negative and anaerobic bacteria, and pain management. The patient is closely monitored for signs of sepsis, peritonitis, and other complications. Surgical intervention, such as laparoscopic or open surgery with possible resection of the affected bowel segment and colostomy formation, is being considered depending on the patient's response to medical management. The patient's condition is documented as diverticular disease with perforation, and ICD-10 code K57.5 is applied. This diagnosis impacts medical billing and coding for hospital services, reflecting the complexity and severity of the patient's condition. Continued monitoring and reassessment are essential to optimize patient outcomes and minimize morbidity and mortality associated with perforated diverticulitis.