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ICD-10 Guide
ICD-10 CodesK25.1

K25.1

Billable

Acute gastric ulcer with perforation

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

Code Description

ICD-10 K25.1 is a billable code used to indicate a diagnosis of acute gastric ulcer with perforation.

Key Diagnostic Point:

Acute gastric ulcer with perforation is a severe gastrointestinal condition characterized by a breach in the gastric wall due to ulceration. This condition typically presents with sudden onset abdominal pain, which may be localized or diffuse, often accompanied by signs of peritonitis, such as rigidity and rebound tenderness. The anatomy involved includes the stomach, particularly the gastric mucosa, which becomes compromised due to factors like excessive NSAID use, alcohol consumption, or stress. Disease progression can lead to significant complications, including hemorrhage, sepsis, and shock if not promptly addressed. Diagnostic considerations include imaging studies such as X-rays or CT scans to confirm perforation, along with laboratory tests to assess for infection or anemia. Early recognition and intervention are crucial to prevent life-threatening outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm perforation.
  • Treatment complexity: Often necessitates surgical intervention and management of complications.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from other gastric ulcer types.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or severity.
  • Documentation gaps: Incomplete clinical notes regarding the patient's condition.
  • Billing challenges: Difficulty in justifying surgical procedures related to perforation.

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 K25.1 is profound, as it represents a critical condition that can lead to high morbidity and mortality if not treated promptly. Population health impact includes increased healthcare utilization due to emergency interventions and potential complications. Quality measures focus on timely diagnosis and treatment, which are essential for improving patient outcomes. Epidemiologically, the incidence of perforated gastric ulcers can reflect broader trends in gastrointestinal health and the effects of lifestyle factors such as diet and medication use.

ICD-9 vs ICD-10

The clinical significance of K25.1 is profound, as it represents a critical condition that can lead to high morbidity and mortality if not treated promptly. Population health impact includes increased healthcare utilization due to emergency interventions and potential complications. Quality measures focus on timely diagnosis and treatment, which are essential for improving patient outcomes. Epidemiologically, the incidence of perforated gastric ulcers can reflect broader trends in gastrointestinal health and the effects of lifestyle factors such as diet and medication use.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for surgical procedures. Best practices include ensuring all clinical notes are thorough, including imaging results, and providing clear justifications for the chosen treatment path to support 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 K25.1?

K25.1 specifically covers acute gastric ulcers that have resulted in perforation, leading to potential peritonitis and requiring urgent medical intervention.

When should K25.1 be used instead of related codes?

K25.1 should be used when there is clear evidence of perforation in the gastric ulcer, as indicated by imaging studies or clinical findings, differentiating it from non-perforated ulcer codes.

What documentation supports K25.1?

Documentation should include clinical findings of perforation, imaging results confirming the diagnosis, and a detailed account of the patient's symptoms and treatment plan.