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ICD-10 Guide
ICD-10 CodesK26.0

K26.0

Billable

Acute duodenal ulcer with hemorrhage

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

Code Description

ICD-10 K26.0 is a billable code used to indicate a diagnosis of acute duodenal ulcer with hemorrhage.

Key Diagnostic Point:

Acute duodenal ulcer with hemorrhage is a serious gastrointestinal condition characterized by a breach in the duodenal mucosa that extends through the muscularis layer, leading to bleeding. The duodenum, the first part of the small intestine, plays a crucial role in digestion, receiving chyme from the stomach and bile from the liver. Clinical presentation often includes severe abdominal pain, nausea, vomiting, and signs of gastrointestinal bleeding such as hematemesis or melena. Disease progression can lead to complications such as perforation, peritonitis, or chronic ulceration if not promptly treated. Diagnostic considerations include endoscopy, which allows for direct visualization of the ulcer and assessment of bleeding, as well as imaging studies and laboratory tests to evaluate hemoglobin levels and overall health status. Timely diagnosis and management are essential to prevent severe complications and ensure patient safety.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and clinical correlation.
  • Treatment complexity: May involve medications, endoscopic interventions, or surgery.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary.
  • Coding specificity: Requires precise coding to differentiate from other ulcer types.

Audit Risk Factors

  • Common coding errors: Misclassification with non-hemorrhagic ulcers.
  • Documentation gaps: Incomplete clinical notes regarding bleeding episodes.
  • Billing challenges: Denials may arise from insufficient documentation of acute episodes.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute duodenal ulcers with hemorrhage have significant clinical implications, often requiring urgent medical intervention. They can lead to increased healthcare utilization, including hospital admissions and surgical interventions. The condition is prevalent in populations with risk factors such as NSAID use, smoking, and Helicobacter pylori infection. Monitoring quality measures related to ulcer management and outcomes is crucial for improving patient care and reducing complications.

ICD-9 vs ICD-10

Acute duodenal ulcers with hemorrhage have significant clinical implications, often requiring urgent medical intervention. They can lead to increased healthcare utilization, including hospital admissions and surgical interventions. The condition is prevalent in populations with risk factors such as NSAID use, smoking, and Helicobacter pylori infection. Monitoring quality measures related to ulcer management and outcomes is crucial for improving patient care and reducing complications.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition, the necessity of procedures such as endoscopy, and the potential for complications. Common denials may occur if documentation does not clearly establish the acute nature of the ulcer or if there is insufficient evidence of hemorrhage. Adhering to coding best practices, including accurate code selection 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 K26.0?

K26.0 specifically covers acute duodenal ulcers that are actively bleeding. This includes ulcers that have resulted in hematemesis or melena, indicating significant hemorrhage.

When should K26.0 be used instead of related codes?

K26.0 should be used when there is clear evidence of an acute duodenal ulcer accompanied by hemorrhage. If the ulcer is chronic or not bleeding, other codes such as K26.9 (duodenal ulcer, unspecified) may be more appropriate.

What documentation supports K26.0?

Documentation should include clinical findings from endoscopy, evidence of bleeding (e.g., lab results showing anemia), and detailed notes on the patient's symptoms and treatment plan.