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ICD-10 Guide
ICD-10 CodesK28.9

K28.9

Billable

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

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

Code Description

ICD-10 K28.9 is a billable code used to indicate a diagnosis of gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation.

Key Diagnostic Point:

Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, refers to an ulcer that occurs at the junction of the stomach and jejunum, which is the first part of the small intestine. Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, and dyspepsia. The anatomy involved includes the stomach, particularly the pyloric region, and the proximal jejunum. Disease progression can vary; while some ulcers may heal spontaneously, others can lead to complications if left untreated. Diagnostic considerations include endoscopy, imaging studies, and laboratory tests to rule out other gastrointestinal conditions. It is crucial to differentiate between acute and chronic ulcers, as management strategies may differ. The unspecified nature of this code indicates that further details regarding the ulcer's characteristics are not provided, necessitating careful clinical evaluation to ascertain the underlying cause and appropriate treatment plan.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to differentiate from other gastrointestinal disorders.
  • Treatment complexity: Management may involve medications, dietary changes, or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical notes are essential to support the diagnosis and treatment plan.
  • Coding specificity: The unspecified nature of the code may lead to ambiguity in coding and billing.

Audit Risk Factors

  • Common coding errors: Misclassification of ulcer type or severity.
  • Documentation gaps: Incomplete clinical notes may lead to denials or audits.
  • Billing challenges: Unspecified codes may result in lower reimbursement rates.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Gastrojejunal ulcers can significantly impact patient quality of life and healthcare utilization, leading to increased hospital visits and potential surgical interventions. Understanding the epidemiology of these ulcers is crucial, as they may be associated with lifestyle factors, medication use, and underlying health conditions. Monitoring quality measures related to ulcer management can help improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

Gastrojejunal ulcers can significantly impact patient quality of life and healthcare utilization, leading to increased hospital visits and potential surgical interventions. Understanding the epidemiology of these ulcers is crucial, as they may be associated with lifestyle factors, medication use, and underlying health conditions. Monitoring quality measures related to ulcer management can help improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the diagnosis aligns with the services rendered. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity. Coders should ensure that the clinical notes clearly support the diagnosis of a gastrojejunal ulcer without complications. Best practices include regular audits of coding accuracy and maintaining up-to-date knowledge of payer policies regarding gastrointestinal conditions.

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 K28.9?

K28.9 covers gastrojejunal ulcers that are not specified as acute or chronic and do not involve hemorrhage or perforation. It includes ulcers that may arise from various etiologies, such as peptic ulcer disease, stress-related mucosal disease, or medication-induced ulcers.

When should K28.9 be used instead of related codes?

K28.9 should be used when the gastrojejunal ulcer is documented without specific details regarding its acuity or complications. If the ulcer is associated with hemorrhage or perforation, the more specific codes (K28.0 or K28.1) should be utilized.

What documentation supports K28.9?

Documentation should include clinical findings, patient history, symptom description, diagnostic test results, and treatment plans. Clear notes indicating the absence of complications and the unspecified nature of the ulcer are essential for appropriate coding.