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ICD-10 Guide
ICD-10 CodesK22.6

K22.6

Billable

Gastro-esophageal laceration-hemorrhage syndrome

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

Code Description

ICD-10 K22.6 is a billable code used to indicate a diagnosis of gastro-esophageal laceration-hemorrhage syndrome.

Key Diagnostic Point:

Gastro-esophageal laceration-hemorrhage syndrome, classified under ICD-10 code K22.6, refers to a severe condition characterized by lacerations in the esophagus leading to significant hemorrhage. This syndrome typically arises from trauma, such as blunt or penetrating injuries, or from severe vomiting, which can cause a rupture in the esophageal lining. The anatomy involved primarily includes the esophagus, which connects the throat to the stomach, and the surrounding vascular structures that may be compromised during laceration. Clinical presentation often includes acute chest pain, hematemesis (vomiting blood), and signs of shock due to blood loss. Disease progression can be rapid, necessitating immediate medical intervention to prevent life-threatening complications. Diagnostic considerations include imaging studies such as CT scans or endoscopy to visualize the extent of the laceration and assess for associated injuries. Prompt diagnosis and treatment are critical to improving patient outcomes and preventing morbidity associated with this condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying the type of laceration or failing to document the cause of injury.
  • Documentation gaps may arise if the clinical notes do not clearly outline the nature of the hemorrhage or the treatment provided.
  • Billing challenges often occur due to the need for extensive documentation to support the severity of the condition and the associated procedures.

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

Trauma 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 K22.6 lies in its potential to lead to severe complications, including shock and death if not promptly addressed. The population health impact is notable, particularly in trauma-prone demographics, as timely intervention can significantly reduce morbidity and mortality rates. Quality measures related to this condition focus on the speed of diagnosis and treatment, influencing healthcare utilization patterns. Epidemiologically, understanding the incidence of gastro-esophageal laceration-hemorrhage syndrome can help inform preventive strategies and improve trauma care protocols.

ICD-9 vs ICD-10

The clinical significance of K22.6 lies in its potential to lead to severe complications, including shock and death if not promptly addressed. The population health impact is notable, particularly in trauma-prone demographics, as timely intervention can significantly reduce morbidity and mortality rates. Quality measures related to this condition focus on the speed of diagnosis and treatment, influencing healthcare utilization patterns. Epidemiologically, understanding the incidence of gastro-esophageal laceration-hemorrhage syndrome can help inform preventive strategies and improve trauma care protocols.

Reimbursement & Billing Impact

Reimbursement considerations include the potential for higher payment rates due to the complexity of care required for this condition. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity for procedures performed. Adhering to coding best practices, including accurate code assignment and comprehensive documentation, is essential for successful billing.

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 K22.6?

K22.6 covers gastro-esophageal laceration-hemorrhage syndrome resulting from trauma or severe vomiting, leading to esophageal tears and significant bleeding. It is crucial to differentiate this from other esophageal conditions such as perforations or strictures.

When should K22.6 be used instead of related codes?

K22.6 should be used when there is clear documentation of laceration and hemorrhage specifically, distinguishing it from codes for perforation or other esophageal disorders. Accurate clinical details are essential for appropriate code selection.

What documentation supports K22.6?

Documentation should include a detailed account of the patient's history, mechanism of injury, clinical findings, imaging results, and treatment provided. Clear notes on the severity of hemorrhage and any surgical interventions are also necessary.