ICD-10 Coding for Duodenal Ulcer(K26.0, K26.4)
Complete ICD-10-CM coding and documentation guide for Duodenal Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Duodenal Ulcer
K26Primary Range
Duodenal ulcer
This range includes all codes related to duodenal ulcers, specifying acuity and complications.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K26.0 | Acute duodenal ulcer with hemorrhage | Use when acute bleeding is confirmed via endoscopy or clinical signs. |
|
| K26.4 | Chronic or unspecified duodenal ulcer with hemorrhage | Use when chronicity is documented and bleeding is present. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for acute duodenal ulcer with hemorrhage
Essential facts and insights about Duodenal Ulcer
Primary ICD-10-CM Codes for duodenal ulcer
Decision Criteria
clinical Criteria
- Active bleeding confirmed by endoscopy
Applicable To
- Acute duodenal ulcer with bleeding
Excludes
- Chronic duodenal ulcer with hemorrhage (K26.4)
Clinical Validation Requirements
- Endoscopy confirming active bleeding
- Hemoglobin drop with melena
Code-Specific Risks
- Misclassification if chronicity is not assessed
Coding Notes
- Ensure documentation specifies 'acute' and 'hemorrhage' to avoid unspecified coding.
K26.4 - Chronic or unspecified duodenal ulcer with hemorrhage
Use when chronicity is documented and bleeding is present.
Applicable To
- Chronic duodenal ulcer with bleeding
Excludes
- Acute duodenal ulcer with hemorrhage (K26.0)
Clinical Validation Requirements
- History of recurrent ulcers with bleeding episodes
Coding Notes
Ensure chronicity is documented to avoid misclassification.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Duodenal Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K26.0.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Ensure endoscopy reports are detailed., Train staff on documentation standards.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure endoscopy findings specify location and type.
Impact
Failure to accurately code complications can lead to audits.
Mitigation Strategy
Regular training and audits of documentation practices.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Duodenal Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Duodenal Ulcer
Use these documentation templates to ensure complete and accurate documentation for Duodenal Ulcer. These templates include all required elements for proper coding and billing.
Acute duodenal ulcer with hemorrhage
Specialty: GastroenterologyRequired Elements
- Endoscopy findings
- Hemoglobin levels
- Patient history of NSAID use
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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