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ICD-10 Guide
ICD-10 CodesK27.6

K27.6

Billable

Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation

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

Code Description

ICD-10 K27.6 is a billable code used to indicate a diagnosis of chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation.

Key Diagnostic Point:

K27.6 refers to a chronic or unspecified peptic ulcer located at an unspecified site, characterized by the presence of both hemorrhage and perforation. Peptic ulcers are open sores that develop on the lining of the stomach, small intestine, or esophagus, primarily due to the erosion caused by stomach acid. The chronic nature of this condition indicates a long-standing ulcer that may have resulted from factors such as Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), or excessive alcohol consumption. Clinically, patients may present with severe abdominal pain, gastrointestinal bleeding, and signs of perforation, such as sudden onset of severe pain, peritonitis, and shock. Diagnostic considerations include endoscopy, imaging studies, and laboratory tests to assess hemoglobin levels and identify the source of bleeding. The management of K27.6 typically involves a combination of medical therapy, such as proton pump inhibitors and antibiotics, and surgical intervention in cases of perforation or uncontrolled hemorrhage.

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 misclassification of ulcer types and complications.
  • Documentation gaps may arise from insufficient clinical details regarding the ulcer's chronicity and complications.
  • Billing challenges often stem from the need for comprehensive documentation to support the severity of the condition.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K27.6 lies in its potential to lead to severe complications, including significant morbidity and mortality if not treated promptly. The population health impact is substantial, as peptic ulcers affect a significant portion of the population, with complications leading to increased healthcare utilization and costs. Quality measures may focus on timely diagnosis and management of ulcers to prevent complications, highlighting the importance of effective healthcare delivery in this area.

ICD-9 vs ICD-10

The clinical significance of K27.6 lies in its potential to lead to severe complications, including significant morbidity and mortality if not treated promptly. The population health impact is substantial, as peptic ulcers affect a significant portion of the population, with complications leading to increased healthcare utilization and costs. Quality measures may focus on timely diagnosis and management of ulcers to prevent complications, highlighting the importance of effective healthcare delivery in this area.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the ulcer and associated complications, which may necessitate surgical intervention. Common denials can occur if documentation does not clearly establish the chronic nature of the ulcer and the presence of hemorrhage and perforation. Best practices include ensuring that all clinical findings, treatment plans, and outcomes are thoroughly documented to support the medical necessity of the services provided.

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 K27.6?

K27.6 covers chronic peptic ulcers with both hemorrhage and perforation. It includes ulcers that may not have a clearly defined site but exhibit severe complications requiring immediate medical attention.

When should K27.6 be used instead of related codes?

K27.6 should be used when a peptic ulcer is chronic and presents with both hemorrhage and perforation. It is essential to differentiate it from codes that represent uncomplicated ulcers or those without hemorrhage.

What documentation supports K27.6?

Documentation must include clinical findings of chronic ulceration, evidence of hemorrhage (e.g., lab results indicating anemia), and confirmation of perforation through imaging or surgical reports.