Gastroenterology Coding Alert

Question: Soon after treating a mass with gastrojejunostomy, the gastroenterologist saw the patient again because she was complaining of abdominal pain. On endoscopic exam, the doctor noted no bleeding in the upper GI tract but he diagnosed the patient with a gastrojejunal ulcer. Which code do I use?

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Answer: Gastroenterologists sometimes see gastrojejunal ulcers pop up after surgical partial gastric removal. When diagnosing this particular ulcer, you only need to focus on the presence or absence of hemorrhage or perforation along with chronicity.

First, 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)

The physician noted the absence of bleeding, so it’s safe to say you can disregard the codes that describe hemorrhage. Take a close look at the notes. If no perforation is mentioned, you may want to query the provider for that detail. If the physician does not share adequate details to select a code, you’ll have to report K28.9.