ICD-10 Coding for Peptic Ulcer Disease(K25.0, K26.1)
Complete ICD-10-CM coding and documentation guide for Peptic Ulcer Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Peptic Ulcer Disease
K25-K28Primary Range
Peptic ulcer disease codes, including gastric, duodenal, and gastrojejunal ulcers
This range covers all types of peptic ulcers, specifying location 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 |
|---|---|---|---|
| K25.0 | Acute gastric ulcer with hemorrhage | Use when an acute gastric ulcer is confirmed with active hemorrhage. |
|
| K26.1 | Acute duodenal ulcer with perforation | Use when an acute duodenal ulcer is confirmed with perforation. |
|
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 peptic ulcer disease
Essential facts and insights about Peptic Ulcer Disease
Primary ICD-10-CM Codes for peptic ulcer disease
Decision Criteria
clinical Criteria
- Presence of active bleeding confirmed by endoscopy
Applicable To
- Acute gastric ulcer with active bleeding
Excludes
- Chronic gastric ulcer with hemorrhage (K25.4)
Clinical Validation Requirements
- Endoscopy report showing active bleeding
- Hemoglobin levels indicating anemia
Code-Specific Risks
- Misclassification if hemorrhage is not documented
Coding Notes
- Ensure documentation specifies 'acute' and 'with hemorrhage' to avoid unspecified coding.
K26.1 - Acute duodenal ulcer with perforation
Use when an acute duodenal ulcer is confirmed with perforation.
Applicable To
- Acute duodenal ulcer with perforation
Excludes
- Chronic duodenal ulcer with perforation (K26.5)
Clinical Validation Requirements
- Surgical report confirming perforation
- Radiological evidence of perforation
Coding Notes
Ensure documentation specifies 'acute' and 'with perforation' to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Helicobacter pylori as the cause of diseases classified elsewhere
B96.81Differential 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 Peptic Ulcer Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K25.0.
Impact
Clinical: May lead to incomplete treatment plans., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of reimbursement for related treatments.
Mitigation Strategy
Include results of H. pylori tests in patient records., Ensure coding staff are aware of ancillary coding requirements.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases accuracy of health data.
Mitigation Strategy
Query providers to specify ulcer type and complications.
Impact
Audits may focus on whether ulcer type and complications are documented with sufficient specificity.
Mitigation Strategy
Implement regular training for providers on documentation requirements.
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 Peptic Ulcer Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Peptic Ulcer Disease
Use these documentation templates to ensure complete and accurate documentation for Peptic Ulcer Disease. These templates include all required elements for proper coding and billing.
Acute gastric ulcer with hemorrhage
Specialty: GastroenterologyRequired Elements
- Patient history
- Endoscopy findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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