ICD-10 Coding for Perforated Gastric Ulcer(K25.1, K25.5)
Complete ICD-10-CM coding and documentation guide for Perforated Gastric Ulcer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Perforated Gastric Ulcer
K25-K28Primary Range
Ulcer of stomach and duodenum
This range includes codes for gastric and duodenal ulcers, specifying acute or chronic conditions 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 |
|---|---|---|---|
| K25.1 | Acute gastric ulcer with perforation | Use when an acute gastric ulcer is confirmed with perforation through imaging or surgery. |
|
| K25.5 | Chronic or unspecified gastric ulcer with perforation | Use when a chronic gastric ulcer is documented with perforation, or if the chronicity is unspecified. |
|
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 gastric ulcer
Essential facts and insights about Perforated Gastric Ulcer
Primary ICD-10-CM Codes for perforated gastric ulcer
Decision Criteria
clinical Criteria
- Presence of acute symptoms and imaging confirmation
documentation Criteria
- Explicit mention of 'acute' and 'perforation'
Applicable To
- Acute gastric ulcer with perforation
Excludes
- Chronic gastric ulcer with perforation (K25.5)
Clinical Validation Requirements
- Imaging showing free air under diaphragm
- Surgical confirmation of perforation
- Symptoms of acute abdomen
Code-Specific Risks
- Misclassification if chronicity is not specified
- Incorrect use if no imaging or surgical confirmation
Coding Notes
- Ensure documentation specifies 'acute' and 'perforation' to use K25.1.
K25.5 - Chronic or unspecified gastric ulcer with perforation
Use when a chronic gastric ulcer is documented with perforation, or if the chronicity is unspecified.
Applicable To
- Chronic gastric ulcer with perforation
Excludes
- Acute gastric ulcer with perforation (K25.1)
Clinical Validation Requirements
- Documentation of chronic ulcer history
- Absence of acute symptoms
Coding Notes
Ensure chronicity is documented to avoid misclassification.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Alcohol dependence with complications
F10.2-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 Perforated Gastric Ulcer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K25.1.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Ensure thorough patient history is taken, Confirm findings with imaging or surgery
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies acute or chronic perforation.
Impact
Risk of audits due to unspecified ulcer chronicity leading to incorrect coding.
Mitigation Strategy
Implement thorough documentation practices specifying acute or chronic nature.
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 Gastric Ulcer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Perforated Gastric Ulcer
Use these documentation templates to ensure complete and accurate documentation for Perforated Gastric Ulcer. These templates include all required elements for proper coding and billing.
Acute perforated gastric ulcer in emergency setting
Specialty: Emergency MedicineRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Surgical confirmation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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