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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK26

K26

Non-billable

Duodenal ulcer

Chapter 11:Diseases of the digestive system

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 K26 is a used to indicate a diagnosis of duodenal ulcer.

Key Diagnostic Point:

Duodenal ulcers are a type of peptic ulcer that occur in the lining of the duodenum, which is the first part of the small intestine. They are characterized by the erosion of the mucosal layer, leading to inflammation and potential complications such as bleeding or perforation. The primary causes of duodenal ulcers include infection with Helicobacter pylori, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and excessive acid production. Clinically, patients may present with symptoms such as abdominal pain, bloating, and nausea, which can significantly impact their quality of life. Proper diagnosis often involves endoscopy or imaging studies to assess the extent of the ulceration and to rule out malignancy.

  • The clinical significance of accurately coding duodenal ulcers lies in their potential complications and the need for appropriate management strategies. Coding for duodenal ulcers under the K26 category allows healthcare providers to track the prevalence of these conditions, ensure proper treatment protocols are followed, and facilitate research into effective interventions. Usage guidelines recommend that K26 codes be utilized when a patient is diagnosed with a duodenal ulcer, whether it is acute or chronic, and when there are associated complications that may require additional coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of complications
  • Need for precise documentation
  • Differentiation from gastric ulcers

Audit Risk Factors

  • Inadequate documentation
  • Misdiagnosis of ulcer type
  • Failure to report complications

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

Primary Care

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 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 impact of the K26 code category extends beyond individual patient care, influencing broader clinical and administrative practices within healthcare systems. Accurate coding of duodenal ulcers contributes to the understanding of disease prevalence and treatment effectiveness, which can inform public health initiatives and resource allocation. Furthermore, as healthcare trends shift towards value-based care, the quality measures associated with duodenal ulcer management become increasingly important. Providers are encouraged to focus on preventive strategies and patient education to reduce the incidence of complications associated with these ulcers.
In terms of population health, the coding and management of duodenal ulcers can help identify at-risk populations and guide interventions aimed at reducing healthcare disparities. By tracking the incidence and outcomes of duodenal ulcers, healthcare organizations can better understand the burden of this condition and implement strategies to improve patient outcomes, ultimately leading to enhanced quality of care and reduced healthcare costs.

ICD-9 vs ICD-10

The impact of the K26 code category extends beyond individual patient care, influencing broader clinical and administrative practices within healthcare systems. Accurate coding of duodenal ulcers contributes to the understanding of disease prevalence and treatment effectiveness, which can inform public health initiatives and resource allocation. Furthermore, as healthcare trends shift towards value-based care, the quality measures associated with duodenal ulcer management become increasingly important. Providers are encouraged to focus on preventive strategies and patient education to reduce the incidence of complications associated with these ulcers. In terms of population health, the coding and management of duodenal ulcers can help identify at-risk populations and guide interventions aimed at reducing healthcare disparities. By tracking the incidence and outcomes of duodenal ulcers, healthcare organizations can better understand the burden of this condition and implement strategies to improve patient outcomes, ultimately leading to enhanced quality of care and reduced healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the ulcer and the treatment provided, such as endoscopic procedures or surgical interventions. It is essential to ensure that all relevant codes are included on the claim to reflect the complexity of the patient's condition and the services rendered. Additionally, providers should be aware of payer-specific guidelines that may affect reimbursement rates for treatments related to duodenal ulcers.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for K26

Coding & Billing References

  • •
    Official ICD-10 Guidelines for K26

Frequently Asked Questions

What conditions are included in K26?

K26 codes cover various types of duodenal ulcers, including acute and chronic forms, as well as ulcers with complications such as bleeding or perforation.

When should I use K26 codes?

K26 codes should be used when a patient is diagnosed with a duodenal ulcer, particularly when there are symptoms present or when complications arise that require specific management.

What documentation is required for K26?

Documentation should include the diagnosis of the duodenal ulcer, details of any complications, the patient's symptoms, and any treatments or interventions that have been performed.