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ICD-10 Guide
ICD-10 CodesK28.3

K28.3

Billable

Acute gastrojejunal ulcer without hemorrhage or perforation

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

Code Description

ICD-10 K28.3 is a billable code used to indicate a diagnosis of acute gastrojejunal ulcer without hemorrhage or perforation.

Key Diagnostic Point:

Acute gastrojejunal ulcer without hemorrhage or perforation is a condition characterized by the formation of an ulcer in the gastrojejunal region, which is the junction between the stomach and the jejunum (the second part of the small intestine). Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, and dyspepsia. The anatomy involved includes the stomach, where gastric acid secretion can contribute to ulcer formation, and the jejunum, where the ulcer can lead to complications if untreated. Disease progression can vary; while some patients may experience resolution with appropriate medical management, others may develop chronic ulcers or complications if the underlying causes, such as Helicobacter pylori infection or NSAID use, are not addressed. Diagnostic considerations include endoscopy for direct visualization of the ulcer, imaging studies, and laboratory tests to rule out other gastrointestinal disorders. Accurate diagnosis is crucial for effective treatment and management of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other gastrointestinal disorders.
  • Treatment complexity: May involve medication management and lifestyle modifications.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis.
  • Coding specificity: Requires precise coding to distinguish from other ulcer types.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or severity.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential denials if documentation does not clearly justify the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

Acute gastrojejunal ulcers can significantly impact patient health and healthcare utilization patterns. They may lead to increased emergency room visits, hospital admissions, and the need for surgical interventions if complications arise. Understanding the epidemiology of this condition helps in developing quality measures aimed at reducing incidence rates and improving patient outcomes. Effective management of gastrojejunal ulcers is crucial for enhancing population health and minimizing healthcare costs.

ICD-9 vs ICD-10

Acute gastrojejunal ulcers can significantly impact patient health and healthcare utilization patterns. They may lead to increased emergency room visits, hospital admissions, and the need for surgical interventions if complications arise. Understanding the epidemiology of this condition helps in developing quality measures aimed at reducing incidence rates and improving patient outcomes. Effective management of gastrojejunal ulcers is crucial for enhancing population health and minimizing healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity is clearly documented, as payers may deny claims if the documentation does not support the diagnosis. Common denials may arise from insufficient clinical evidence or misclassification of the ulcer type. It is essential to follow coding best practices, including using the most specific code available and ensuring that all related services are accurately captured in the billing process.

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 K28.3?

K28.3 specifically covers acute gastrojejunal ulcers that are not complicated by hemorrhage or perforation. It is important to differentiate this condition from chronic ulcers and other gastrointestinal disorders.

When should K28.3 be used instead of related codes?

K28.3 should be used when the ulcer is confirmed to be acute and without complications such as bleeding or perforation. If there are signs of hemorrhage or perforation, the appropriate related codes (K28.0 or K28.1) should be utilized.

What documentation supports K28.3?

Documentation should include clinical findings, diagnostic imaging results, endoscopy reports, and treatment plans. Clear notes indicating the absence of complications are essential for supporting the use of K28.3.