ICD-10 Coding for Perforated Duodenal Ulcer(K26.1, K26.5)
Complete ICD-10-CM coding and documentation guide for Perforated Duodenal Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Perforated Duodenal Ulcer
K26.0-K26.9Primary Range
Duodenal ulcer codes covering various complications
This range includes codes for duodenal ulcers with different complications such as hemorrhage, perforation, and combinations thereof.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K26.1 | Acute duodenal ulcer with perforation | Use when the ulcer is acute and perforation is confirmed. |
|
| K26.5 | Chronic or unspecified duodenal ulcer with perforation | Use when the ulcer is chronic or acuity is not specified. |
|
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 perforated duodenal ulcer
Essential facts and insights about Perforated Duodenal Ulcer
Primary ICD-10-CM Codes for perforated duodenal ulcer
Decision Criteria
clinical Criteria
- Acute onset with imaging confirmation
documentation Criteria
- Explicit mention of 'acute' and 'perforation'
Applicable To
- Acute perforated duodenal ulcer
Excludes
- Chronic duodenal ulcer with perforation (K26.5)
Clinical Validation Requirements
- Sudden onset epigastric pain
- Imaging confirming free air (CT)
- Operative findings of perforation
Code-Specific Risks
- Misclassification as chronic if acuity is not documented
Coding Notes
- Ensure documentation specifies 'acute' to avoid defaulting to chronic codes.
K26.5 - Chronic or unspecified duodenal ulcer with perforation
Use when the ulcer is chronic or acuity is not specified.
Applicable To
- Chronic perforated duodenal ulcer
Excludes
- Acute duodenal ulcer with perforation (K26.1)
Clinical Validation Requirements
- History of PUD
- Gradual symptom progression
- Endoscopic evidence of chronic mucosal changes
Coding Notes
Ensure documentation specifies 'chronic' or 'unspecified' to avoid defaulting to acute codes.
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.
Perforated peptic ulcer, site unspecified
K27.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Perforated Duodenal Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K26.1.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of reimbursement due to incorrect DRG assignment.
Mitigation Strategy
Educate providers on documentation requirements, Implement checklist for ulcer documentation
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment and reimbursement., Compliance: May result in compliance issues if coding does not match documentation., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation Strategy
Ensure documentation specifies whether the ulcer is acute or chronic.
Impact
Failure to document acuity can lead to incorrect coding.
Mitigation Strategy
Implement documentation audits and provider education.
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 Perforated Duodenal Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Perforated Duodenal Ulcer
Use these documentation templates to ensure complete and accurate documentation for Perforated Duodenal Ulcer. These templates include all required elements for proper coding and billing.
Acute Perforated Duodenal Ulcer
Specialty: GastroenterologyRequired Elements
- Patient history
- Imaging findings
- Operative details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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