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ICD-10 Guide
ICD-10 CodesK25.3

K25.3

Billable

Acute gastric ulcer without hemorrhage or perforation

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

Code Description

ICD-10 K25.3 is a billable code used to indicate a diagnosis of acute gastric ulcer without hemorrhage or perforation.

Key Diagnostic Point:

K25.3 refers to an acute gastric ulcer without hemorrhage or perforation, a condition characterized by a sudden onset of ulceration in the gastric mucosa. This condition typically presents with symptoms such as epigastric pain, nausea, vomiting, and potential dyspepsia. The anatomy involved includes the stomach, particularly the gastric lining, which becomes compromised due to factors such as excessive gastric acid secretion, the use of non-steroidal anti-inflammatory drugs (NSAIDs), or infection with Helicobacter pylori. Disease progression can lead to chronic ulcers if not treated, potentially resulting in complications such as perforation or hemorrhage. Diagnostic considerations include endoscopy, which allows direct visualization of the ulcer, and biopsy to rule out malignancy. Laboratory tests may also be performed to assess for H. pylori infection and to evaluate the patient's overall health status. Early diagnosis and management are crucial to prevent complications and promote healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and possibly biopsy for confirmation.
  • Treatment complexity: Management may involve proton pump inhibitors, lifestyle modifications, and addressing underlying causes.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment plans.
  • Coding specificity: Requires precise coding to differentiate from other gastric ulcer types.

Audit Risk Factors

  • Common coding errors: Misclassification with other gastric ulcer codes.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K25.3 lies in its potential to progress to more severe conditions if left untreated. It affects a substantial portion of the population, particularly those with risk factors such as NSAID use and H. pylori infection. Understanding the epidemiology of gastric ulcers can inform public health strategies aimed at prevention and early intervention. Quality measures related to the management of gastric ulcers can enhance healthcare utilization patterns and improve patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K25.3 lies in its potential to progress to more severe conditions if left untreated. It affects a substantial portion of the population, particularly those with risk factors such as NSAID use and H. pylori infection. Understanding the epidemiology of gastric ulcers can inform public health strategies aimed at prevention and early intervention. Quality measures related to the management of gastric ulcers can enhance healthcare utilization patterns and improve patient outcomes.

Reimbursement & Billing Impact

reimbursement. Regular audits can help identify areas for improvement in documentation and coding practices.

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 K25.3?

K25.3 covers acute gastric ulcers that are characterized by sudden onset and do not involve hemorrhage or perforation. It is important to differentiate this from chronic ulcers or those with complications.

When should K25.3 be used instead of related codes?

K25.3 should be used when the patient presents with an acute gastric ulcer that has been confirmed through diagnostic procedures, and there are no signs of bleeding or perforation. It is essential to document the absence of these complications.

What documentation supports K25.3?

Documentation should include clinical findings from physical examinations, results from endoscopic evaluations, and any relevant laboratory tests. Clear notes on the absence of hemorrhage or perforation are crucial.