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ICD-10 Guide
ICD-10 CodesK22.11

K22.11

Billable

Ulcer of esophagus with bleeding

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

Code Description

ICD-10 K22.11 is a billable code used to indicate a diagnosis of ulcer of esophagus with bleeding.

Key Diagnostic Point:

K22.11 refers to an ulcer of the esophagus with bleeding, a serious condition that can arise from various etiologies including gastroesophageal reflux disease (GERD), infections, or malignancies. The esophagus, a muscular tube connecting the throat to the stomach, can develop ulcers due to prolonged exposure to acidic gastric contents or other irritants. Clinically, patients may present with symptoms such as dysphagia (difficulty swallowing), odynophagia (painful swallowing), hematemesis (vomiting blood), or melena (black, tarry stools). Disease progression can lead to significant complications, including perforation or strictures, necessitating urgent medical intervention. Diagnostic considerations include endoscopy, which allows direct visualization of the esophagus and potential biopsy of suspicious lesions. Imaging studies and laboratory tests may also be employed to assess the extent of bleeding and underlying causes. Early diagnosis and management are crucial to prevent severe outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation including endoscopy and possibly imaging.
  • Treatment complexity: May involve medications, lifestyle modifications, or surgical interventions.
  • Documentation requirements: Detailed clinical notes and diagnostic findings are essential.
  • Coding specificity: Requires precise coding to differentiate from other esophageal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of ulcer or failure to document bleeding.
  • Documentation gaps: Incomplete clinical notes regarding the severity and treatment of the ulcer.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

Internal Medicine

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

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 K22.11 lies in its potential for severe complications, including hemorrhage and esophageal perforation, which can lead to increased healthcare utilization and hospitalization. Understanding the epidemiology of esophageal ulcers is crucial, as they can affect diverse populations, particularly those with chronic conditions like GERD. Quality measures related to timely diagnosis and management of esophageal ulcers can improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

The clinical significance of K22.11 lies in its potential for severe complications, including hemorrhage and esophageal perforation, which can lead to increased healthcare utilization and hospitalization. Understanding the epidemiology of esophageal ulcers is crucial, as they can affect diverse populations, particularly those with chronic conditions like GERD. Quality measures related to timely diagnosis and management of esophageal ulcers can improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

The clinical significance of K22.11 lies in its potential for severe complications, including hemorrhage and esophageal perforation, which can lead to increased healthcare utilization and hospitalization. Understanding the epidemiology of esophageal ulcers is crucial, as they can affect diverse populations, particularly those with chronic conditions like GERD. Quality measures related to timely diagnosis and management of esophageal ulcers can improve patient outcomes and reduce healthcare costs.

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 K22.11?

K22.11 covers esophageal ulcers that are actively bleeding, which may be due to various causes such as reflux disease, infections, or malignancies. It is crucial to document the cause of the ulcer and the presence of bleeding for accurate coding.

When should K22.11 be used instead of related codes?

K22.11 should be used when there is clear documentation of an esophageal ulcer accompanied by bleeding. If the ulcer is present without bleeding, K22.10 should be utilized instead.

What documentation supports K22.11?

Documentation must include clinical findings from endoscopy, evidence of bleeding (e.g., hematemesis), and any relevant imaging studies. Detailed notes on the patient's symptoms and treatment plan are also necessary.