Diverticular Disease of the Colon J005

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: K57.2, K57.3

Brief description

Diverticular disease of the colon is a condition where diverticula (abnormal sacs or pouches) form at weak points in the wall of the colon. These pouches develop due to straining during bowel movements or chronic constipation. 

This SOP covers diverticulosis (without inflammation - whether symptomatic or not) and diverticulitis (with inflammation). Complications of colonic diverticular disease (diverticular bleeding, perforation of a diverticulum, diverticular abscess and diverticulitis complicated by fistula) are also covered by the SOP.

Confirming the diagnosis

To diagnose asymptomatic diverticulosis, colonoscopy, CT scan, or other imaging is required. Diverticulitis and symptomatic disease are usually diagnosed based on clinical evaluation supported by imaging. The gold standard for diagnosing diverticulitis is a CT scan of the abdomen and pelvis with contrast, which can confirm inflammation and detect complications such as abscess, perforation or fistula. Blood tests may reveal elevated inflammatory markers, and additional investigations may be needed to exclude other causes of abdominal pain. Colonoscopy is generally deferred until after resolution of acute inflammation to rule out malignancy or other structural pathologies. 

General practitioners are often the first to assess and diagnose diverticular disease, particularly uncomplicated cases. However, for confirmation, management of complications, or when the diagnosis is uncertain, the expertise of a gastroenterologist or general/colorectal surgeon is often required. 

Additional diagnoses covered by SOP

• Diverticulitis of the colon
• Diverticulosis of the colon
• Diverticulae of the colon
• Diverticular abscess
• Diverticular bleeding
• Diverticular stricture
• Diverticulitis complicated by bowel obstruction
• Diverticulitis complicated by fistula
• Perforation of a diverticulum

Conditions not covered by SOP

• Diverticular disease of the small intestine #
• Diverticular disease of the bladder #

* another SOP applies- the SOP has the same name unless otherwise specified

# non- SOP condition

Clinical onset

In most cases, clinical onset is taken to be the time of diagnosis, as symptoms are typically non-specific and do not reliably allow for backdating to an earlier point in time. 

Clinical worsening

The normal course of diverticulosis can vary considerably. Many individuals remain asymptomatic, while approximately 25% may experience complications such as bleeding or episodes of diverticulitis. Most cases of uncomplicated diverticulitis respond well to medical management; however, around 15% may ultimately require surgical intervention. Clinical worsening may be indicated by progression from diverticulosis to diverticulitis, or by the emergence of diverticulitis-related complications, such as bleeding, abscess formation, perforation, or fistula. Determining whether a deterioration exceeds the expected course of the disease may require input from a specialist.