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ICD-10 Guide
ICD-10 CodesK26.6

K26.6

Billable

Chronic or unspecified duodenal ulcer with both hemorrhage and perforation

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

Code Description

ICD-10 K26.6 is a billable code used to indicate a diagnosis of chronic or unspecified duodenal ulcer with both hemorrhage and perforation.

Key Diagnostic Point:

K26.6 refers to a chronic or unspecified duodenal ulcer that is complicated by both hemorrhage and perforation. The duodenum is the first section of the small intestine, and ulcers in this area can arise due to various factors including Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and excessive alcohol consumption. Clinically, patients may present with severe abdominal pain, hematemesis (vomiting blood), melena (black, tarry stools), and signs of peritonitis due to perforation. The disease progression can lead to significant complications, including internal bleeding and peritoneal infection, which can be life-threatening. Diagnosis typically involves endoscopy, imaging studies, and laboratory tests to assess hemoglobin levels and confirm the presence of an ulcer. Prompt diagnosis and treatment are crucial to prevent further complications and manage symptoms effectively.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differentiation from other gastrointestinal conditions.
  • Treatment complexity: May necessitate surgical intervention in cases of perforation and hemorrhage.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to capture the complexity of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or severity.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history or treatment.
  • Billing challenges: Potential denials due to insufficient documentation or lack of specificity.

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

General Surgery

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 K26.6 lies in its potential to lead to severe complications, including shock and sepsis, which can increase healthcare utilization and costs. The population health impact is notable, as duodenal ulcers are prevalent in adults, particularly those with risk factors such as NSAID use and H. pylori infection. Quality measures focus on timely diagnosis and management to prevent complications, highlighting the importance of effective healthcare delivery in managing gastrointestinal disorders.

ICD-9 vs ICD-10

The clinical significance of K26.6 lies in its potential to lead to severe complications, including shock and sepsis, which can increase healthcare utilization and costs. The population health impact is notable, as duodenal ulcers are prevalent in adults, particularly those with risk factors such as NSAID use and H. pylori infection. Quality measures focus on timely diagnosis and management to prevent complications, highlighting the importance of effective healthcare delivery in managing gastrointestinal disorders.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of treatment, which may involve surgical intervention, and the need for comprehensive documentation to justify the medical necessity of procedures performed. Common denials may arise from insufficient detail in clinical notes or failure to demonstrate the severity of the condition. Best practices include ensuring that all relevant clinical information is captured and that coding aligns with the documentation provided.

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 K26.6?

K26.6 covers chronic or unspecified duodenal ulcers that are complicated by both hemorrhage and perforation. This includes cases where the ulcer has not healed and has led to significant complications requiring urgent medical attention.

When should K26.6 be used instead of related codes?

K26.6 should be used when both hemorrhage and perforation are present in a chronic or unspecified duodenal ulcer. If only one complication is present, the appropriate code for that specific condition should be selected.

What documentation supports K26.6?

Documentation should include clinical findings from endoscopy, imaging results, laboratory tests indicating anemia or bleeding, and detailed notes on the patient's symptoms and treatment plan. Evidence of both hemorrhage and perforation must be clearly documented.