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ICD-10 Guide
ICD-10 CodesK25.7

K25.7

Billable

Chronic gastric ulcer without hemorrhage or perforation

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

Code Description

ICD-10 K25.7 is a billable code used to indicate a diagnosis of chronic gastric ulcer without hemorrhage or perforation.

Key Diagnostic Point:

Chronic gastric ulcer without hemorrhage or perforation (K25.7) refers to a long-standing ulceration of the gastric mucosa that does not present with active bleeding or perforation of the stomach wall. Clinically, patients may experience symptoms such as epigastric pain, nausea, and dyspepsia. The anatomy involved includes the stomach, particularly the gastric mucosa, which can become inflamed and ulcerated due to factors such as Helicobacter pylori infection, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), or excessive alcohol consumption. Disease progression can lead to complications if left untreated, including the potential for gastric cancer. Diagnostic considerations for K25.7 include endoscopy, which allows for direct visualization of the ulcer, and biopsy to rule out malignancy. Additionally, imaging studies may be employed to assess the extent of the ulceration and to monitor healing over time. Proper diagnosis is crucial to differentiate chronic ulcers from acute conditions, which may require different management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to differentiate from other gastrointestinal conditions.
  • Treatment complexity: Management may involve lifestyle modifications, medication, and monitoring.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to ensure accurate representation of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of acute versus chronic ulcers.
  • Documentation gaps: Incomplete clinical notes that do not fully describe the condition.
  • Billing challenges: Potential denials due to lack of supporting documentation for chronicity.

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

Chronic gastric ulcers significantly impact patient quality of life and can lead to increased healthcare utilization due to complications if not managed properly. They are prevalent in populations with high rates of NSAID use and H. pylori infections. Effective management of K25.7 can improve patient outcomes and reduce the burden on healthcare systems by preventing complications such as bleeding or perforation, which require more intensive interventions.

ICD-9 vs ICD-10

Chronic gastric ulcers significantly impact patient quality of life and can lead to increased healthcare utilization due to complications if not managed properly. They are prevalent in populations with high rates of NSAID use and H. pylori infections. Effective management of K25.7 can improve patient outcomes and reduce the burden on healthcare systems by preventing complications such as bleeding or perforation, which require more intensive interventions.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough clinical notes that justify the diagnosis and any treatments provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the condition. Best practices include maintaining clear communication with the patient regarding their treatment plan and ensuring all relevant information is captured in the medical record to support claims.

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 K25.7?

K25.7 specifically covers chronic gastric ulcers that are not associated with hemorrhage or perforation. It is important to differentiate these from acute ulcers or those with complications, as treatment and management strategies may differ.

When should K25.7 be used instead of related codes?

K25.7 should be used when a patient is diagnosed with a chronic gastric ulcer that does not present with any signs of bleeding or perforation. If the ulcer is acute or has complications, other codes such as K25.0 or K25.1 should be utilized.

What documentation supports K25.7?

Documentation supporting K25.7 should include clinical notes detailing the patient's symptoms, diagnostic test results (such as endoscopy findings), treatment plans, and any follow-up assessments that confirm the chronic nature of the ulcer.