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ICD-10 Guide
ICD-10 CodesK28.5

K28.5

Billable

Chronic or unspecified gastrojejunal ulcer with perforation

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

Code Description

ICD-10 K28.5 is a billable code used to indicate a diagnosis of chronic or unspecified gastrojejunal ulcer with perforation.

Key Diagnostic Point:

Chronic or unspecified gastrojejunal ulcer with perforation is a serious gastrointestinal condition characterized by the formation of an ulcer in the gastrojejunal region, which is the junction between the stomach and the jejunum (the second part of the small intestine). Clinically, patients may present with severe abdominal pain, nausea, vomiting, and signs of peritonitis due to the perforation, which can lead to leakage of gastric contents into the abdominal cavity. The anatomy involved includes the stomach, jejunum, and surrounding structures such as the peritoneum. Disease progression can lead to complications such as sepsis, abscess formation, and significant morbidity if not addressed promptly. Diagnostic considerations include imaging studies like CT scans to confirm perforation and endoscopy for direct visualization and assessment of the ulcer. Laboratory tests may also be performed to evaluate for signs of infection or anemia resulting from chronic blood loss. Early diagnosis and intervention are crucial to prevent life-threatening complications associated with this condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly endoscopic evaluation to confirm diagnosis.
  • Treatment complexity: Often necessitates surgical intervention and management of complications.
  • Documentation requirements: Detailed clinical documentation is essential to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other types of ulcers.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or failure to document perforation.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and treatment.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis of 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

Chronic gastrojejunal ulcers with perforation have significant clinical implications, often leading to emergency interventions and increased healthcare utilization. The condition can impact population health through increased morbidity and mortality rates associated with gastrointestinal complications. Quality measures may focus on timely diagnosis and treatment to prevent complications, while epidemiological considerations include understanding the prevalence of ulcer disease and its risk factors within the population.

ICD-9 vs ICD-10

Chronic gastrojejunal ulcers with perforation have significant clinical implications, often leading to emergency interventions and increased healthcare utilization. The condition can impact population health through increased morbidity and mortality rates associated with gastrointestinal complications. Quality measures may focus on timely diagnosis and treatment to prevent complications, while epidemiological considerations include understanding the prevalence of ulcer disease and its risk factors within the population.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the necessity for surgical intervention. Common denials may arise from insufficient documentation of the perforation or lack of clarity in the treatment plan. It is essential to ensure that all clinical notes, imaging results, and surgical reports are complete and accurately reflect the patient's diagnosis and treatment to avoid billing issues. Coding best practices include using the most specific code available and ensuring that all related procedures are appropriately linked to the diagnosis.

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 K28.5?

K28.5 covers chronic gastrojejunal ulcers that have progressed to perforation. This includes ulcers that may have been previously diagnosed as chronic but have developed complications leading to perforation.

When should K28.5 be used instead of related codes?

K28.5 should be used when there is clear documentation of a perforated gastrojejunal ulcer. If the ulcer is chronic but not perforated, K28.4 should be used instead.

What documentation supports K28.5?

Documentation should include clinical findings, imaging results confirming perforation, treatment plans, and any surgical notes if applicable. Detailed notes on the patient's symptoms and history of ulcer disease are also crucial.