ICD-10 Coding for H. pylori Infection(B96.81, K25.9)
Complete ICD-10-CM coding and documentation guide for H. pylori Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to H. pylori Infection
Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
Used as a secondary code to specify H. pylori as the causative agent for conditions like ulcers or gastritis.
K25-K29Primary Range
Gastric and duodenal ulcers, gastritis and duodenitis
Primary codes for conditions often associated with H. pylori infection.
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 confirmed as the causative agent for a primary condition like an ulcer or gastritis. |
|
| K25.9 | Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation | Use as a primary code when a gastric ulcer is confirmed, and H. pylori is identified as the causative agent. |
|
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 H. pylori
Essential facts and insights about H. pylori Infection
Primary ICD-10-CM Codes for hours pylori
Decision Criteria
clinical Criteria
- Confirmed H. pylori infection via testing
coding Criteria
- Use only as a secondary code
Applicable To
- H. pylori infection as a secondary diagnosis
Excludes
- Primary diagnosis without a linked condition
Clinical Validation Requirements
- Positive urea breath test
- Stool antigen test
- Endoscopic biopsy confirmation
Code-Specific Risks
- Incorrectly using as a primary diagnosis
Coding Notes
- Ensure proper sequencing with primary condition codes.
K25.9 - Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
Use as a primary code when a gastric ulcer is confirmed, and H. pylori is identified as the causative agent.
Applicable To
- Gastric ulcer confirmed by endoscopy
Excludes
- Ulcer with hemorrhage or perforation
Clinical Validation Requirements
- Endoscopic confirmation of ulcer
Coding Notes
Ensure documentation specifies ulcer location and H. pylori confirmation.
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.
Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K26.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting H. pylori Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B96.81.
Impact
Clinical: Potential misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Claim denials due to insufficient documentation.
Mitigation Strategy
Specify diagnostic method and results in documentation.
Impact
Reimbursement: Claims may be denied if B96.81 is used incorrectly., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data on H. pylori-related conditions.
Mitigation Strategy
Always use B96.81 as a secondary code with a primary condition like K25.9.
Impact
Using B96.81 as a primary code instead of secondary.
Mitigation Strategy
Educate coders on proper sequencing rules.
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 H. pylori Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for H. pylori Infection
Use these documentation templates to ensure complete and accurate documentation for H. pylori Infection. These templates include all required elements for proper coding and billing.
H. pylori-associated gastric ulcer
Specialty: GastroenterologyRequired Elements
- Primary condition diagnosis
- H. pylori confirmation method
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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