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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:

Peptic UlcerDuodenal Ulceration

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

CodeDescriptionWhen to UseKey Documentation
K26.0Acute duodenal ulcer with hemorrhageUse when acute bleeding is confirmed via endoscopy or clinical signs.
  • Endoscopy confirming active bleeding
  • Hemoglobin drop with melena
K26.4Chronic or unspecified duodenal ulcer with hemorrhageUse when chronicity is documented and bleeding is present.
  • History of recurrent ulcers with bleeding episodes

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

The ICD-10 code for an acute duodenal ulcer with hemorrhage is K26.0, used when active bleeding is confirmed.

Primary ICD-10-CM Codes for duodenal ulcer

Acute duodenal ulcer with hemorrhage
Billable Code

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.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Alcohol dependence with withdrawal

F10.231
Use if alcohol use is a contributing factor.

Helicobacter pylori as the cause of diseases classified elsewhere

B96.81
Use if H. pylori infection is confirmed.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Acute gastric ulcer with hemorrhage

K25.0
Use K25.0 if the ulcer is located in the stomach rather than the duodenum.

Chronic gastric ulcer with hemorrhage

K25.4
Use K25.4 if the ulcer is located in the stomach.

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: Gastroenterology

Required Elements

  • Endoscopy findings
  • Hemoglobin levels
  • Patient history of NSAID use

Example Documentation

Patient presents with melena and hematemesis. Endoscopy reveals an acute duodenal ulcer with active bleeding. Hemoglobin at 9.0 g/dL.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Duodenal ulcer observed.
Good Documentation Example
Acute duodenal ulcer with active bleeding confirmed on EGD.
Explanation
The good example provides specificity on acuity and bleeding status.

Need help with ICD-10 coding for Duodenal Ulcer? Ask your questions below.

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