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ICD-10 Guide
ICD-10 CodesK26.9

K26.9

Billable

Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation

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

Code Description

ICD-10 K26.9 is a billable code used to indicate a diagnosis of duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation.

Key Diagnostic Point:

Duodenal ulcers are open sores that develop on the lining of the duodenum, the first part of the small intestine. The condition can present with symptoms such as abdominal pain, bloating, and nausea, often exacerbated by hunger or certain foods. The anatomy involved includes the duodenum, which is situated just after the stomach and plays a crucial role in digestion by receiving chyme and bile. Disease progression can vary; while some patients may experience intermittent symptoms, others may have persistent discomfort. The ulcers can be caused by factors such as Helicobacter pylori infection, excessive use of NSAIDs, or stress. Diagnostic considerations include endoscopy, which allows direct visualization of the ulcer, and tests for H. pylori. K26.9 is used when the specific characteristics of the ulcer are not documented, and it is essential to differentiate it from other gastrointestinal conditions such as gastric ulcers (K25) or peptic ulcers with complications (K27).

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other gastrointestinal disorders.
  • Treatment complexity: May involve medication management or lifestyle changes.
  • Documentation requirements: Must include symptomatology and diagnostic tests.
  • Coding specificity: Non-specific code may lead to ambiguity in clinical documentation.

Audit Risk Factors

  • Common coding errors: Misclassification with gastric ulcers or peptic ulcers with complications.
  • Documentation gaps: Lack of detailed clinical notes may lead to incorrect coding.
  • Billing challenges: Insufficient documentation may result in claim denials.

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 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

Duodenal ulcers significantly impact population health, as they can lead to complications if left untreated, such as bleeding or perforation. Quality measures focus on appropriate diagnosis and management to reduce the incidence of complications. Understanding the epidemiology of duodenal ulcers, including risk factors such as H. pylori infection and NSAID use, is crucial for healthcare providers to implement preventive strategies and improve patient outcomes.

ICD-9 vs ICD-10

Duodenal ulcers significantly impact population health, as they can lead to complications if left untreated, such as bleeding or perforation. Quality measures focus on appropriate diagnosis and management to reduce the incidence of complications. Understanding the epidemiology of duodenal ulcers, including risk factors such as H. pylori infection and NSAID use, is crucial for healthcare providers to implement preventive strategies and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation that justifies the medical necessity of procedures performed, such as endoscopy. Common denials may arise from insufficient documentation or failure to provide evidence of the ulcer's characteristics. Best practices include maintaining detailed clinical notes and ensuring that all relevant diagnostic tests are documented to support the claim.

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 K26.9?

K26.9 covers duodenal ulcers that are unspecified as acute or chronic, without hemorrhage or perforation. This includes cases where the ulcer's characteristics are not clearly documented, making it essential to ensure thorough clinical evaluation.

When should K26.9 be used instead of related codes?

K26.9 should be used when the documentation does not specify the type of duodenal ulcer or its complications. If the ulcer is documented as acute or chronic with specific details, then more specific codes (K26.0-K26.8) should be utilized.

What documentation supports K26.9?

Documentation supporting K26.9 should include clinical notes detailing the patient's symptoms, diagnostic test results (e.g., endoscopy findings), and any treatment plans. Clear documentation of the absence of complications is also crucial.