ICD-10 Coding for Gastric Ulcer(K25.0, K25.5)
Complete ICD-10-CM coding and documentation guide for Gastric Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gastric Ulcer
K25Primary Range
Gastric ulcer
This range includes all types of gastric ulcers, categorized by acute, chronic, and complications such as hemorrhage and perforation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K25.0 | Acute gastric ulcer with hemorrhage | Use when there is documented acute gastric ulcer with active bleeding. |
|
| K25.5 | Chronic gastric ulcer with perforation | Use when there is documented chronic gastric ulcer with perforation. |
|
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 gastric ulcer with hemorrhage
Essential facts and insights about Gastric Ulcer
Primary ICD-10-CM Codes for gastric ulcer
Decision Criteria
clinical Criteria
- Presence of active bleeding on EGD
documentation Criteria
- Documentation of acute status and hemorrhage
Applicable To
- Acute gastric ulcer with bleeding
Excludes
- Chronic gastric ulcer with hemorrhage (K25.4)
Clinical Validation Requirements
- EGD report showing active bleeding
- Hemoglobin <10 g/dL
Code-Specific Risks
- Misclassification if hemorrhage is not documented
Coding Notes
- Ensure documentation specifies 'acute' and 'hemorrhage' to avoid unspecified coding.
K25.5 - Chronic gastric ulcer with perforation
Use when there is documented chronic gastric ulcer with perforation.
Applicable To
- Chronic gastric ulcer with perforation
Excludes
- Acute gastric ulcer with perforation (K25.1)
Clinical Validation Requirements
- CT evidence of pneumoperitoneum
- Surgical confirmation of perforation
Coding Notes
Ensure documentation specifies 'chronic' and 'perforation' to avoid unspecified coding.
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 Gastric Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K25.0.
Impact
Clinical: May lead to inadequate treatment planning, Regulatory: Increases risk of audit and compliance issues, Financial: Potential for reduced reimbursement
Mitigation Strategy
Ensure thorough documentation of EGD findings, Regular training on documentation standards
Impact
Reimbursement: May lead to lower DRG assignment and reduced reimbursement, Compliance: Increases risk of audit due to unspecified coding, Data Quality: Impacts accuracy of clinical data and reporting
Mitigation Strategy
Ensure documentation specifies hemorrhage to use K25.0
Impact
High risk of audit if ulcers are coded without specifying complications.
Mitigation Strategy
Ensure detailed documentation of ulcer type and complications.
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 Gastric Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gastric Ulcer
Use these documentation templates to ensure complete and accurate documentation for Gastric Ulcer. These templates include all required elements for proper coding and billing.
Acute gastric ulcer with hemorrhage
Specialty: GastroenterologyRequired Elements
- Patient history
- EGD findings
- Hemoglobin levels
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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