ICD-10 Coding for Gastrointestinal Ulcer(K25.0, K26.9)
Complete ICD-10-CM coding and documentation guide for Gastrointestinal Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gastrointestinal Ulcer
K25-K28Primary Range
Gastric, duodenal, peptic, and gastrojejunal ulcers
This range covers all types of ulcers in the gastrointestinal tract, including specific locations and complications.
Helicobacter pylori as the cause of diseases classified elsewhere
Used to identify H. pylori infection as an etiology for ulcers.
Alcohol related disorders
Relevant when alcohol use is a contributing factor to ulcer development.
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 active bleeding from a gastric ulcer confirmed by endoscopy. |
|
| K26.9 | Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation | Use when the duodenal ulcer is confirmed but lacks specification of acute or chronic status and has no complications. |
|
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 Gastrointestinal Ulcer
Primary ICD-10-CM Codes for gastrointestinal ulcer
Decision Criteria
clinical Criteria
- Active bleeding observed during endoscopy
documentation Criteria
- Explicit mention of acute hemorrhage
Applicable To
- Acute gastric ulcer with bleeding
Excludes
- Chronic gastric ulcer with hemorrhage (K25.4)
Clinical Validation Requirements
- Endoscopic confirmation of active bleeding
- Hemoglobin levels indicating anemia
Code-Specific Risks
- Misclassification if chronicity is not documented
Coding Notes
- Ensure documentation specifies acute nature and presence of hemorrhage.
K26.9 - Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
Use when the duodenal ulcer is confirmed but lacks specification of acute or chronic status and has no complications.
Applicable To
- Unspecified duodenal ulcer
Excludes
- Acute duodenal ulcer with hemorrhage (K26.0)
Clinical Validation Requirements
- Endoscopic findings of duodenal ulcer without complications
Coding Notes
Ensure documentation clarifies the absence of complications.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Helicobacter pylori as the cause of diseases classified elsewhere
B96.81Differential 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 Gastrointestinal 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 affect treatment decisions, Regulatory: Increases audit risk, Financial: Potential for reduced reimbursement
Mitigation Strategy
Always specify if the ulcer is acute or chronic, Review endoscopy findings thoroughly
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Increases risk of audit issues, Data Quality: Decreases the accuracy of clinical data
Mitigation Strategy
Always document and code the specific location and nature of the ulcer.
Impact
High risk of audit if unspecified codes are used when specific details are available.
Mitigation Strategy
Ensure thorough documentation of ulcer specifics 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 Gastrointestinal Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gastrointestinal Ulcer
Use these documentation templates to ensure complete and accurate documentation for Gastrointestinal Ulcer. These templates include all required elements for proper coding and billing.
Acute gastric ulcer with hemorrhage
Specialty: GastroenterologyRequired Elements
- Patient history
- Endoscopy findings
- Lab results
- Medication history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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