Gastroenterology Coding Alert

Can you select the right ICD-10 code for these scenarios?

When your GI physician sees a patient with an ulcer, your coding can come down to differentiating acute from chronic, and pinpointing the right location. While this may seem easy, ulcer coding can actually be quite challenging.

To ensure that you understand how to report ulcers at your GI practice, take the following quiz and evaluate your ulcer coding prowess.

Acute vs. Chronic May Not Be Simple

Question 1: A patient presents with an ulcer that he’s only been experiencing for two weeks. Does this mean the ulcer should be classified as acute?

Answer 1: Not necessarily. Unfortunately, the decision to separate acute from chronic was not made by clinicians, and providers can’t readily distinguish acute from chronic for an ulcer, with a few exceptions. Most gastroenterologists will typically classify an ulcer as chronic if considerable scarring exists, or if the patient has a long history (usually at least three months) of ulcer symptoms.

However, there are situations that may seem acute that are actually chronic. For instance, if a patient starts an NSAID and develops an ulcer a few weeks later, you might assume it qualifies as acute. However, that patient may have had chronic asymptomatic ulcer disease.

Typically, you’ll have to leave the decision of chronic or acute up to the physician, but if the doctor doesn’t specify it in the documentation, you may need to ask them for more information before choosing the best diagnosis code.

Can You Code a Duodenal Ulcer?

Question 2: A 76-year-old patient presents with burning, sharp pain in their upper abdominal area, and the gastroenterologist performs an endoscopy. The doctor then diagnoses the patient with a duodenal ulcer. Which code applies?

Answer 2: To select the right duodenal ulcer code, you’ll need to know whether the issue was chronic or acute, and whether an obstruction, hemorrhage, or perforation was present.

When you see the K26 (Duodenal ulcer) category, you’ll notice that a fourth character is required. To pinpoint the most accurate fourth character, you’ll need some detail from the gastroenterologist’s report. If the condition is acute, you’ll look to the K26.0-K26.3 codes (Acute duodenal ulcer …), which are broken down further based on whether the acute duodenal ulcer had hemorrhage, perforation, both, or neither.

If you find that the patient suffers from chronic duodenal ulcers or you don’t have any indication of whether the condition as acute or chronic, you’ll instead need to look at K26.40-K26.7 (Chronic or unspecified duodenal ulcer…) series. These codes also expand further depending on the presence of hemorrhage, perforation, neither, or both.

Finally, your only remaining option is K26.9 (Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation). This code is less specific and you’ll only report it if the gastroenterologist’s record lacks information about whether the ulcer was acute or chronic in nature. In cases of sparse documentation when the physician is unable to add more details, you should turn to this code.

Nail Down the Right Gastric Ulcer Codes

Question 3: A 68-year-old patient presents to your practice with severe stomach pain and says they have been passing black stools over the past several weeks. The gastroenterologist diagnoses them with an acute gastric ulcer with hemorrhage. Which code should you report?

Answer 3: Your first step is to review the K25 (Gastric ulcer) section of the ICD-10 code set. The list of inclusions will add on acute erosion of the stomach, while exclusion lists will also comprise acute gastritis (K29.0-).

To pinpoint the most appropriate code, you’ll need to differentiate between the codes for acute gastric ulcers (K25.0- K25.3) and chronic (K25.4-K25.7). In this case, you know that the patient has an acute gastric ulcer with a hemorrhage, so your options are K25.0 (Acute gastric ulcer with hemorrhage) or K25.2 (Acute gastric ulcer with both hemorrhage and perforation), because these are the only two codes that describe an acute gastric ulcer with hemorrhaging.

To decide between the two, check the patient record for mention of perforation. If perforation is not present, then K25.0 is the correct code for you.

Know What Constitutes a Gastrojejunal Ulcer

Question 4: A patient who recently was treated with gastrojejunostomy for an ulcer or tumor returns to the practice complaining of abdominal pain without any bleeding in the upper GI tract. On endoscopic exam, the gastroenterologist diagnoses the patient with a gastrojejunal ulcer, which occurs sometimes after surgical partial gastric removal. Which code should you report?

Answer 4: When reporting a diagnosis of gastrojejunal ulcer, you’ll need to focus only on presence or absence of hemorrhage or perforation along with chronicity, but you won’t need to know whether an obstruction was involved.

To start on your coding journey, you’ll look to the K28 (Gastrojejunal ulcer) section of the ICD-10 code set.

You’ll then have to further expand K28 to identify the presence or absence of hemorrhage and perforation, which means you’ll have to scour the medical record to get more details. Based on hemorrhage and perforation, you’ll have to choose from the following nine expansions to K28:

• K28.0 (Acute gastrojejunal ulcer with hemorrhage)
• K28.1 (… with perforation)
• K28.2 (… with both hemorrhage and perforation)
• K28.3 (… without hemorrhage or perforation)
• K28.4 (Chronic or unspecified gastrojejunal ulcer with hemorrhage)
• K28.5 (… with perforation)
• K28.6 (… with both hemorrhage and perforation)
• K28.7 (Chronic gastrojejunal ulcer without hemorrhage or perforation)
• K28.9 (Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation)

Depending on the information you find in the patient’s record, you’ll select the most appropriate code from this list. If the physician does not share adequate details to select a code, you’ll have to report K28.9.