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ICD-10 Guide
ICD-10 CodesK92.1

K92.1

Billable

Melena

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

Code Description

ICD-10 K92.1 is a billable code used to indicate a diagnosis of melena.

Key Diagnostic Point:

Melena refers to the passage of black, tarry stools, which is indicative of upper gastrointestinal bleeding. The black coloration is due to the digestion of blood as it passes through the gastrointestinal tract. Common causes of melena include peptic ulcers, esophageal varices, gastritis, and malignancies. The anatomy involved primarily includes the stomach and the upper part of the small intestine, where bleeding typically occurs. Disease progression can vary; if the underlying cause is not identified and treated promptly, it may lead to significant blood loss, anemia, and potentially life-threatening complications. Diagnostic considerations for melena include a thorough patient history, physical examination, and diagnostic tests such as endoscopy, which can help identify the source of bleeding. Laboratory tests, including complete blood count (CBC) and coagulation studies, are also essential to assess the severity of blood loss and the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation to determine the source of bleeding.
  • Treatment complexity: May involve endoscopic procedures, surgery, or medical management depending on the cause.
  • Documentation requirements: Requires detailed documentation of symptoms, diagnostic tests, and treatment plans.
  • Coding specificity: Specific to upper gastrointestinal bleeding, necessitating accurate coding to reflect the underlying cause.

Audit Risk Factors

  • Common coding errors: Misidentification of the source of bleeding or failure to document the underlying cause.
  • Documentation gaps: Incomplete records regarding patient history or diagnostic findings.
  • Billing challenges: Potential denials due to lack of specificity in documentation or coding.

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

Melena has significant clinical implications as it often indicates serious underlying conditions that require prompt intervention. The population health impact is notable, as gastrointestinal bleeding can lead to increased hospitalizations and healthcare utilization. Quality measures related to timely diagnosis and treatment of upper GI bleeding are critical for improving patient outcomes and reducing morbidity associated with this condition.

ICD-9 vs ICD-10

Melena has significant clinical implications as it often indicates serious underlying conditions that require prompt intervention. The population health impact is notable, as gastrointestinal bleeding can lead to increased hospitalizations and healthcare utilization. Quality measures related to timely diagnosis and treatment of upper GI bleeding are critical for improving patient outcomes and reducing morbidity associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation of the diagnosis, any procedures performed, and the medical necessity of treatments. Common denials may arise from insufficient documentation or lack of specificity in coding. Best practices include maintaining clear and detailed records of patient encounters, diagnostic tests, and treatment plans to support the claim and reduce the risk of audits.

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 K92.1?

K92.1 covers melena resulting from various conditions such as peptic ulcers, esophageal varices, and malignancies of the upper gastrointestinal tract. It is crucial to document the underlying cause to ensure accurate coding.

When should K92.1 be used instead of related codes?

K92.1 should be used when the patient presents with black, tarry stools indicative of upper GI bleeding. It is important to differentiate it from K92.0 (Hematemesis) and other codes that may pertain to lower GI bleeding.

What documentation supports K92.1?

Documentation should include a detailed history of the patient's symptoms, results from diagnostic tests (such as endoscopy), and any identified underlying conditions contributing to melena.