ICD-10 Coding for Helicobacter pylori(B96.81, K25.9)
Complete ICD-10-CM coding and documentation guide for Helicobacter pylori. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Helicobacter pylori
Bacterial and viral infectious agents
Includes codes for infectious agents as the cause of diseases classified elsewhere, such as B96.81 for H. pylori.
K20-K31Primary Range
Diseases of esophagus, stomach, and duodenum
Primary range for conditions like gastritis and ulcers that can be caused by H. pylori.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B96.81 | Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere | Use as a secondary code when H. pylori is documented as the cause of another condition. |
|
| K25.9 | Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation | Use as a primary code for gastric ulcers, especially when linked to H. pylori. |
|
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 Helicobacter pylori
Essential facts and insights about Helicobacter pylori
Primary ICD-10-CM Codes for helicobacter pylori
Decision Criteria
documentation Criteria
- Explicit documentation of H. pylori as the cause of the condition.
Applicable To
- H. pylori infection as a secondary cause
Excludes
- Carrier status without active disease (Z22.3)
Clinical Validation Requirements
- Positive urea breath test
- Positive stool antigen test
- Endoscopic biopsy confirmation
Code-Specific Risks
- Incorrectly using as a primary code
- Assuming causation without documentation
Coding Notes
- Always sequence B96.81 after the primary condition code.
K25.9 - Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
Use as a primary code for gastric ulcers, especially when linked to H. pylori.
Applicable To
- Gastric ulcer due to H. pylori
Excludes
- Gastritis without ulcer (K29.70)
Clinical Validation Requirements
- Endoscopic findings
- Biopsy results
Coding Notes
Ensure documentation specifies ulcer location and cause.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K25.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Helicobacter pylori to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B96.81.
Impact
Clinical: Misrepresentation of patient condition, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Ensure documentation explicitly states causation, Verify test results before coding
Impact
Reimbursement: Incorrect sequencing can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always use B96.81 as a secondary code with a primary condition code.
Impact
Lack of explicit documentation linking H. pylori to the condition.
Mitigation Strategy
Implement documentation templates that require causation statements.
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 Helicobacter pylori, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Helicobacter pylori
Use these documentation templates to ensure complete and accurate documentation for Helicobacter pylori. These templates include all required elements for proper coding and billing.
H. pylori-induced gastritis
Specialty: GastroenterologyRequired Elements
- Patient symptoms
- Endoscopic findings
- Test results confirming H. pylori
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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