ICD-10 Coding for Melena(K92.1, K25.0)
Complete ICD-10-CM coding and documentation guide for Melena. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Melena
K92.0-K92.9Primary Range
Other diseases of digestive system
This range includes codes for various digestive system disorders, including melena.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K92.1 | Melena | Use when melena is present and the underlying cause is unknown or not documented. |
|
| K25.0 | Acute gastric ulcer with hemorrhage | Use when melena is due to a confirmed bleeding gastric ulcer. |
|
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 melena
Essential facts and insights about Melena
Primary ICD-10-CM Codes for melena
Decision Criteria
clinical Criteria
- Presence of black tarry stools and positive fecal occult blood test.
documentation Criteria
- Lack of documented underlying cause.
Applicable To
- Black tarry stools
Clinical Validation Requirements
- Positive fecal occult blood test
- Endoscopy findings of upper GI bleeding
- Drop in hemoglobin levels
Code-Specific Risks
- Risk of undercoding if underlying cause is known but not documented.
Coding Notes
- Ensure documentation clearly states if the cause of melena is unknown.
K25.0 - Acute gastric ulcer with hemorrhage
Use when melena is due to a confirmed bleeding gastric ulcer.
Applicable To
- Bleeding gastric ulcer
Excludes
- Chronic gastric ulcer with hemorrhage (K25.4)
Clinical Validation Requirements
- Endoscopy showing bleeding gastric ulcer
Coding Notes
Ensure endoscopy findings are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other fecal abnormalities
R19.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Hemorrhage of anus and rectum
K62.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Melena to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K92.1.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Ensure thorough documentation of diagnostic tests., Use templates to capture all necessary information.
Impact
Reimbursement: May affect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of clinical scenario.
Mitigation Strategy
Use only K25.0 if the bleeding gastric ulcer is confirmed.
Impact
High risk of audit if K92.1 is used without clear documentation of the cause.
Mitigation Strategy
Ensure all diagnostic tests and findings are documented.
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 Melena, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Melena
Use these documentation templates to ensure complete and accurate documentation for Melena. These templates include all required elements for proper coding and billing.
Gastroenterology consult for melena
Specialty: GastroenterologyRequired Elements
- History of present illness
- Endoscopy findings
- Hemoglobin levels
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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