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ICD-10 Guide
ICD-10 CodesK25.9

K25.9

Billable

Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K25.9 is a billable code used to indicate a diagnosis of gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation.

Key Diagnostic Point:

Gastric ulcers are localized lesions in the gastric mucosa that can arise due to various factors, including excessive gastric acid secretion, infection with Helicobacter pylori, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The clinical presentation of a gastric ulcer may include epigastric pain, nausea, vomiting, and dyspepsia. The anatomy involved primarily includes the stomach, particularly the gastric mucosa, which is susceptible to damage from acidic gastric secretions. Disease progression can vary; some patients may experience chronic ulcers that can lead to complications such as hemorrhage or perforation, while others may have acute episodes that resolve with treatment. Diagnostic considerations for K25.9 include a thorough patient history, physical examination, and potentially endoscopic evaluation to visualize the ulcer and rule out malignancy. Laboratory tests may also be conducted to identify H. pylori infection and assess gastric acid levels. It is crucial to differentiate K25.9 from other related codes, such as K25.0-K25.8, which specify gastric ulcers with hemorrhage or perforation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other gastrointestinal conditions.
  • Treatment complexity: Moderate, involving medication management and lifestyle modifications.
  • Documentation requirements: Requires detailed clinical documentation to support the diagnosis.
  • Coding specificity: Moderate, as it is essential to specify the ulcer's characteristics.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or severity.
  • Documentation gaps: Incomplete patient history or lack of endoscopic findings.
  • Billing challenges: Denials due to insufficient documentation supporting the diagnosis.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K25.9 lies in its prevalence as a common gastrointestinal disorder, impacting a significant portion of the population. Gastric ulcers can lead to increased healthcare utilization due to complications if not properly managed. Understanding the epidemiology of gastric ulcers, including risk factors such as NSAID use and H. pylori infection, is crucial for preventive measures and quality care. Effective management of gastric ulcers can improve patient outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

The clinical significance of K25.9 lies in its prevalence as a common gastrointestinal disorder, impacting a significant portion of the population. Gastric ulcers can lead to increased healthcare utilization due to complications if not properly managed. Understanding the epidemiology of gastric ulcers, including risk factors such as NSAID use and H. pylori infection, is crucial for preventive measures and quality care. Effective management of gastric ulcers can improve patient outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical information is included in the patient's medical record, and that the coding accurately reflects the patient's condition and treatment plan. Familiarity with payer-specific guidelines can also aid in reducing billing challenges.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K25.9?

K25.9 covers gastric ulcers that are unspecified as acute or chronic, without complications such as hemorrhage or perforation. It is important to note that this code does not apply to ulcers that have been documented with specific characteristics or complications.

When should K25.9 be used instead of related codes?

K25.9 should be used when the gastric ulcer is not specified as acute or chronic and does not involve hemorrhage or perforation. If the ulcer has specific characteristics or complications, the corresponding specific code (K25.0-K25.8) should be utilized.

What documentation supports K25.9?

Documentation for K25.9 should include a clear diagnosis of a gastric ulcer, patient symptoms, any relevant diagnostic tests (such as endoscopy), and treatment plans. It is essential to document the absence of complications to justify the use of this code.